Laparoscopic Adjustable Gastric Banding in a Patient with an Incidental <I>Para-Hiatal</I> Hernia

Abstract

Laparoscopic adjustable gastric banding (LAGB) in patients with a sliding hiatus hernia has become an accepted procedure. However, LAGB in patients with less common types of diaphragmatic hernia is rarely described. We report a super-super-obese woman with a para-hiatal hernia (non-hiatal, diaphragmatic hernia) where LAGB was performed. The para-hiatal hernia was successfully repaired laparoscopically at the same time that the LAGB was performed. A para-hiatal hernia is not a contraindication to LAGB and can be repaired at the same operation.

Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery

“…There were, of course, many findings (such as gastritis) that are of no relevance to the choice of bariatric procedure. On the other hand, there were findings, such as hiatal or paraesophageal hernia, which may be exacerbated after AGB [11][12][13][14]: peptic ulcers may be problematic in SG if the resection line runs through the ulcer or in RYGBP if the ulcer is located in the gastric remnant and ulcer bleeding occurs during the postoperative course [30]; submucous tumors or polyps should be extendedly diagnosed by endoscopic ultrasound and (endoscopically) resected before any bariatric procedure when indicated, because morbid obesity is an independent risk factor for the development of upper gastrointestinal malignancies and because there are reports of incidental intraoperative findings of gastric tumors during bariatric surgery [31].…”

“…However, there is evidence that the chosen procedure might be changed, if specific pathological upper GI findings are known preoperatively. For example, gastric banding should be avoided in cases of known hiatal or paraesophageal hernia [11][12][13][14] or gastric bypass is recommended in cases of Barrett's esophagus caused by GERD [14,15]. Because morbidly obese patients per se are at high perioperative risk, the chosen procedure should be as safe as possible.…”

Another type of diaphragmatic hernia to remember: parahiatal hernia

“…The search identified 16 relevant articles published in the language of English. [1][2][3][4][5][8][9][10][11][12][13][14][15][16][17] Together with two cases from our clinical work, a total of 27 parahiatal hernia patients were included in the present study; 15 cases were female, 12 cases were male, the average age was 51.8 years old (range: 4-80 years old). The overview and summarized data are presented in Tables 1 and 2, respectively.…”

“…As shown in Tables 1 and 2, none of them were pre‐operatively diagnosed. The pre‐operative diagnosis included: diaphragmatic eventration (one case),0010 Bochdalek hernia (one case),9 incidental finding during laparoscopic adjustable gastric banding (one case)0011 and paraoesophageal hernias in 24 cases. Therefore, the majority of the patients (24/27) were pre‐operatively diagnosed as paraoesophageal hernias.…”

“…One must bear in mind that, parahiatal hernia could be found incidentally,0011 and it could also co‐exist with other types of diaphragmatic hernias, including paraoesophageal hernia 0016. Therefore, although parahiatal hernia is unlikely to be differentiated pre‐operatively from paraoesophageal hernias due to the similar symptoms and radiological image, it is important to suspect and recognize the presence of parahiatal hernia intra‐operatively, especially when repairing an unusual‐appearing ‘hiatus’ hernia.…”