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

Thomopoulos, Théodoros; FitzGerald, Maurice; Mantziari, Styliani; Demartines, Nicolas; Suter, Michel

doi:10.1007/s11695-021-05881-1

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…ITSM with HH is a well-known cause of GERD, dysphagia and epigastric pain after MBS but has a high rate of missed diagnoses because the presenting complaints are assumed to be simple post-MBS GERD which is often managed conservatively. 41 In a report by Saba et al, 42 the incidence of ITSM has been reported to be up to 72.5% after MBS. Potential mechanisms for recurrent ITSM include excessive manipulation of the diaphragmatic crura, a surgical section of anchoring phrenogastric and phrenoesophageal ligaments, dissection of the angle of His, and loss of the hiatal fat pad secondary to rapid weight loss.…”

Section: Discussionmentioning

confidence: 97%

“…Our meta-analysis revealed a low incidence of gastric sleeve migration after LTA. ITSM with HH is a well-known cause of GERD, dysphagia and epigastric pain after MBS but has a high rate of missed diagnoses because the presenting complaints are assumed to be simple post-MBS GERD which is often managed conservatively 41 . In a report by Saba et al, 42 the incidence of ITSM has been reported to be up to 72.5% after MBS.…”

Section: Discussionmentioning

confidence: 99%

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Ligamentum Teres Augmentation for Hiatus Hernia Repair After Bariatric Surgery: A Systematic Review and Meta-analysis

Chaudhry,

Farsi,

Nakanishi

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Objective: Hiatal hernia (HH) and symptomatic gastroesophageal reflux disease are common complications after metabolic bariatric surgery. This meta-analysis aims to investigate the safety and efficacy of ligamentum teres augmentation (LTA) for HH repair after metabolic and bariatric surgeries (MBS). Materials and Methods: CENTRAL, Embase, PubMed, and Scopus were searched for articles from their inception to September 2023 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis system. Results: Five studies met the eligibility criteria, with a total of 165 patients undergoing LTA for HH repair after MBS. The distribution of patients based on surgical procedures included 63% undergoing sleeve gastrectomy, 21% Roux-en-Y gastric bypass, and 16% having one anastomosis gastric bypass. The pooled proportion of reflux symptoms before LTA was 77% (95% CI: 0.580-0.960; I 2 = 89%, n = 106). A pooled proportion of overall postoperative symptoms was 25.6% (95% CI: 0.190-0.321; I 2 = 0%, n = 44), consisting of reflux at 14.5% (95% CI: 0.078-0.212; I 2 = 0%, n = 15). The pooled proportion of unsuccessful LTA outcomes was 12.5% (95% CI: 0.075-0.175; I 2 = 0%, n = 21). Conclusion: Our meta-analysis demonstrated that LTA appears to be a safe and efficacious procedure in the management of HH after MBS.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Ligamentum Teres Augmentation for Hiatus Hernia Repair After Bariatric Surgery: A Systematic Review and Meta-analysis

Chaudhry,

Farsi,

Nakanishi

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The management of surgical emergencies during pregnancy following MBS is another topic of interest, which is predicted to increase over the following years, owing to the increase in metabolic bariatric operations worldwide [ 54 , 55 ], the improvement of female fertility following MBS [ 56 , 57 ], and the reduction of visceral fat that may serve as a predisposing mechanism for the formation of internal hernias [ 58 , 59 ]. Typically, the acute abdomen after MBS is treated laparoscopically; however, special considerations that apply to pregnancy should be addressed effectively before deciding the surgical access [ 60 ].…”

Section: Reviewmentioning

confidence: 99%

Laparoscopic Surgery During Pregnancy: A Meta-Review and Quality Analysis Using the Assessment of Multiple Systematic Reviews (AMSTAR) 2 Instrument

Pantelis,

Machairiotis,

Stavros

et al. 2024

Cureus

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Accumulation of experience with minimally invasive surgery over the last three decades has rendered laparoscopic surgery the mainstay of management for surgical pathology during pregnancy. In the present meta-review, we compiled the available evidence on the safety of laparoscopic and robotic-assisted surgeries during pregnancy, based on relevant systematic reviews (SR) and meta-analyses (MA). A systematic review was performed for articles published until February 2024 in English using PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) and Google Scholar based on predefined selection and exclusion criteria. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included SRs and MAs examining women of childbearing age (population) who had undergone laparoscopic surgery or robotic-assisted laparoscopic surgery during pregnancy (intervention). The presence of comparison to open surgery was desirable but not mandatory (comparator). The included studies should necessarily report on fetal loss (outcome), and optionally on other metrics of fetal, maternal, or operative performance. We considered SRs/MAs analyzing randomized trials, observational studies, case reports, and case series (study design). The methodological quality of SRs/MAs not exclusively including case reports and case series was assessed with the Assessment of Multiple Systematic Reviews (AMSTAR) 2 instrument. A total of 1229 articles were screened, of which 78 were potentially eligible. Of these, 33 articles met our inclusion criteria, 18 containing SRs only and 15 SRs with MA. The examined disciplines were laparoscopic appendectomy (10 studies, 30.3%), laparoscopic cerclage for cervical insufficiency (eight studies, 24.2%), adnexal-ovarian laparoscopic surgery (five studies, 15.2%), laparoscopic cholecystectomy and biliary tree exploration (three studies, 9.1%), laparoscopic myomectomy (two studies, 6.1%), and one study each for laparoscopic surgery regarding pancreatic indications, adrenal indications, and bariatric complications (3.0%). The odds ratio/relative risk for fetal loss rate ranged from 0-1.9, with variable statistical significance depending on the discipline. Twenty-three out of the 33 studies were submitted to quality evaluation with the AMSTAR 2 instrument, with three being of “low quality” (13.0%) and the remaining 20 of “critically low quality” (87.0%). In conclusion, the widespread acceptance of laparoscopic surgery for treating surgical pathology during pregnancy is substantiated by heterogeneous and low-quality evidence. Literature mainly revolves around laparoscopic appendectomy, whereas other disciplines that may commonly arise during pregnancy, such as cholecystectomy and the acute abdomen following bariatric surgery, are underrepresented in the literature. Factors such as anatomical alterations that may affect surgical access, surgeon’s expertise, and the biological course of the underlying pathology should be taken into consideration when selecti...

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“…The evidence on HH post-RYGB is based on case reports and case series, among which the largest one includes 7 patients [87][88][89][90]. In this context, HH constitutes a late complication, with patients presenting 2-14 years following the index RYGB procedure.…”

Section: Hiatal Hernia After Roux-en-y Gastric Bypassmentioning

confidence: 99%

“…In this context, HH constitutes a late complication, with patients presenting 2-14 years following the index RYGB procedure. Several mechanisms have been proposed to contribute to this condition, including rapid weight loss after MBS which is associated with relaxation of the phrenoesophageal ligament of Laimer and widening of the hiatus, creation of a large pouch with an ensuing higher intragastric pressure, extended dissection of the cardia and the left crus, or a small pre-existing hernia that enlarges over time [90][91][92]…”

Section: Hiatal Hernia After Roux-en-y Gastric Bypassmentioning

confidence: 99%

Hernia as a Complication of Metabolic Bariatric Surgery

Pantelis,

Bhandari

2023

Hernia Updates and Approaches

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Metabolic Bariatric Surgery (MBS) is increasingly gaining ground, given that it constitutes the most effective treatment of obesity and associated health problems, with enduring results and a well-documented safety profile. Nevertheless, certain issues may rise in the medium and long term. Among them, there is a heterogeneous group of complications under the umbrella term “post-bariatric hernia”, including internal hernias, abdominal wall hernias, and hiatal hernias. Internal hernias constitute the most studied category, but evidence on the other categories is not lacking. This chapter will attempt to cover diagnostic, treatment, and preventive aspects in the management of hernia post-MBS following a comprehensive, evidence-based approach. In brief, with regards to the prevention of internal hernias, suturing of all defects is strongly recommended for Roux-en-Y Gastric Bypass (RYGB), but the evidence is less clear when it comes to newer bypass procedures, such as One-Anastomosis/Mini Gastric Bypass (OAGB/MGB) and Single Anastomosis Duodenal-Ileal Bypass (SADI). As far as abdominal wall hernias are concerned, there is no clear evidence of the advantages of suture closure against non-closure. Finally, with respect to hiatal hernias post-MBS, the caveat rests in the documentation of de novo versus pre-existing hiatal hernia, which mandates meticulous preoperative evaluation of symptoms and potentially further endoscopic documentation.

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

Abstract: Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Cited by 6 publications

References 9 publications

Ligamentum Teres Augmentation for Hiatus Hernia Repair After Bariatric Surgery: A Systematic Review and Meta-analysis

Ligamentum Teres Augmentation for Hiatus Hernia Repair After Bariatric Surgery: A Systematic Review and Meta-analysis

Laparoscopic Surgery During Pregnancy: A Meta-Review and Quality Analysis Using the Assessment of Multiple Systematic Reviews (AMSTAR) 2 Instrument

Hernia as a Complication of Metabolic Bariatric Surgery

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