The Results of Hiatal Hernia not Amended During Gastric Banding – A Case Report and the Conclusions Stemming from it
Journal Title: Journal of Obesity and Bariatrics - Year 2016, Vol 3, Issue 2
Abstract
Introduction: Hiatal hernia is frequent in patients undergoing bariatric surgery [1].There is evidence that laparoscopic gastric banding is associated with deterioration of GERD, however, the treatment of a hiatal hernia accidentally discovered during a LGB is still under debate. We would like to use the current case report to shed some light upon the decision not to close a hiatal hernia discovered accidentally during Lap band, and its grave consequences. Patient description: A 36 old female, with a known LGB, was admitted to the Urology ward due to suspected nephrolithiasis and Left flank pain. Deterioration in her status and worsening of the LUQ pain has led to a CT with subsequent drain insertion due to a suspected effusion. A follow up CT showed the stomach in the left hemithorax, with the drain inserted in the upper border of the stomach. The patient was taken to the OR, and there a multidisciplinary team of general and cardiothoracic surgeons operated upon her. In the operation a left thoracotomy was done to enable the reduction of the stomach back to the abdomen and a thorough drainage of the left chest. After that, in a formal laparotomy a sleeve gastrectomy was done due to necrosis of the greater curvature. An esophagostomy was performed to enable diversion of esophageal content from the stomach. Discussion and conclusions: Many changes have occurred in thebariatric field since the 1990’s when hiatal hernia was considered a contraindication for LAGB. But, a change of paradigm has occurred, and just like our patient has shown, not operating upon a hiatal hernia during LAGB is extremely dangerous for the patient. From this stems only one conclusion - If one encounters a hiatal band during a LAGB procedure, be it a primary or revisional one, one has to fix this defect or else endanger his patient unnecessarily
Authors and Affiliations
Zvi Perry
Keywords
Related Articles
- EP ID EP205490
- DOI 10.13188/2377-9284.1000020
- Views 98
- Downloads 0
Pediatric Gastric Bypass: Is it Time to Rethink? Lessons Learned from a Single Institution Experience
Pediatric obesity is a growing problem in United States. Ideally, a non-operative option is preferred but currently there is no medical treatment that guarantees an enduring weight loss. Laparoscopic adjustable gastric b...
An Anatomical Point to Start Transection in Laparoscopic Sleeve Gastrectomy
Introduction: Laparoscopic Sleeve Gastrectomy (LSG) has become a preferred primary bariatric surgical approach. However, some technical aspects still lack standardization, including the distance from the pylorus at which...
Post-Surgical Effects of Roux-En-Y Gastric Bypass on Glucose Homeostasis, Intestinal Morphology and L-Cells in Obese Gottingen Minipigs
Background: Roux-en-Y gastric bypass (RYGB) is currently the most effective treatment of morbid obesity in man. In rodents, RYGB leads to a number of morphological changes in the intestine. However, little is known about...
Portomesentric Vein Thrombosis: Our Experience of 3527 Laparoscopic Bariatric Surgery Procedures in Qatar
Background: Portomesentric vein thrombosis (PMVT) is a rare but potentially serious and life threatening complication that may happen following laparoscopic bariatric surgery (LBS). Multifactorial local and systemic prot...
The Impacts of Childhood and Adolescent Obesity on Quality of Life
Obesity is important and its affects are not only limited to adults and medical conditions, but also may affect children and adolescents and may have overarching effects on social parameters. Programs to prevent the nega...