Augmentation of Hiatal Repair with the Ligamentum Teres Hepatis for Intrathoracic Gastric Migration After Bariatric Surgery

Runkel, Alexander; Scheffel, Oliver; Marjanović, Goran; Chiappetta, Sonja; Runkel, N.

doi:10.1007/s11695-020-05153-4

Cited by 21 publications

(11 citation statements)

References 25 publications

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“…ITSM can be a major cause of nausea, dysphagia, and postoperative reflux disease. Because of the risk of up to 50% in the long term after surgery, it is mostly discussed in the context of LSG [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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Acute Intrathoracic Migration With Incarceration of Laparoscopic Sleeve Gastrectomy Due to Incomplete Hiatal Hernia Repair

Dalkılıç¹,

Erdem²,

Gençtürk³

et al. 2022

Cureus

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Concomitant hiatal hernia repair during laparoscopic sleeve gastrectomy (LSG) is recommended if it is detected. Intrathoracic sleeve migration (ITSM) is a sliding hiatal hernia that develops after LSG. In this article, we present an early ITSM due to an incomplete repair of a hiatal hernia.An obese patient had hiatal hernia in the preoperative endoscopy. After LSG, the defect was repaired with anterior cruroplasty. Vomiting attacks were observed after the operation. Based on clinical signs and radiological findings, laparoscopic exploration was indicated. During the reoperation, an acute entrapment of the upper portion of the sleeve was observed, which had migrated through the hiatus. This suture was undone. There was no gastric ischemia. No additional hiatal repair was attempted.The operation was sufficient to alleviate the symptoms. The patient was discharged on the second postoperative day uneventfully. Until the most recent follow-up, the patient has progressed with adequate weight loss, without complaints of reflux and without proton pump inhibitors ITSM with incarceration is a complication that can occur after incomplete hiatal repair. Failure to perform hiatal repair with proper technique can be attributed to this complication.

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Section: Discussionmentioning

confidence: 99%

“…Mesh reinforcement with hiatoplasty can be performed in selected patients [ 14 ]. Although all these techniques are interesting, their long-term results are still unknown and their routine use removes the most attractive feature of LSG, its technical simplicity [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Intrathoracic Migration With Incarceration of Laparoscopic Sleeve Gastrectomy Due to Incomplete Hiatal Hernia Repair

Dalkılıç¹,

Erdem²,

Gençtürk³

et al. 2022

Cureus

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show abstract

“…Since only case reports and small cohort studies regarding cruroplasty/hiatal hernia repair alone and other investigational techniques alone exist, quality of evidence is low and the results of the current literature are not promising [20][21][22][23]. Even though, it seems, that reflux symptoms continue [24].…”

Section: Symptomatic Gerd After Sg and Adequate Weight Lossmentioning

confidence: 99%

“…No consensus was achieved for cruroplasty and hiatal hernia repair. It is important to evidence intrathoracic gastric pouch migration, a newly described entity, which may be addressed in redo-surgery [22,31]. Further studies are necessary to underline its significance.…”

Section: Symptomatic Gerd After Sg and Inadequate Weight Loss/weight ...mentioning

confidence: 99%

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redoprocedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

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“…Various surgical techniques have been described in the literature to address HH and IMGP after LRYGB, yet these reports are sporadic and inconsistent. Among them, the hiatoplasty with the ligamentum teres hepatis [ 8 ], or a modified Nissen procedure using the fundus of the excluded stomach, may be valid options [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Management of a Late-Term Hiatal Hernia with Intrathoracic Pouch Migration After Roux-en-Y Gastric Bypass

et al. 2022

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Augmentation of Hiatal Repair with the Ligamentum Teres Hepatis for Intrathoracic Gastric Migration After Bariatric Surgery

Cited by 21 publications

References 25 publications

Acute Intrathoracic Migration With Incarceration of Laparoscopic Sleeve Gastrectomy Due to Incomplete Hiatal Hernia Repair

Acute Intrathoracic Migration With Incarceration of Laparoscopic Sleeve Gastrectomy Due to Incomplete Hiatal Hernia Repair

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Management of a Late-Term Hiatal Hernia with Intrathoracic Pouch Migration After Roux-en-Y Gastric Bypass

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