Our Summary

This research paper focuses on the inconsistent way surgeons diagnose and repair hiatal hernias (HH) during weight loss surgeries. A hiatal hernia is a condition where part of your stomach pushes through your diaphragm into your chest, and it’s common among patients undergoing weight loss surgery. However, there’s no agreed-upon method of diagnosing and repairing these hernias before or during surgery.

The researchers looked at nearly 3,500 weight loss surgeries performed across four hospitals by eleven surgeons. They found that hiatal hernias were repaired during just under a quarter of these surgeries. The methods used to diagnose hiatal hernias before surgery varied significantly among surgeons, as did the rates at which they repaired these hernias.

The study concluded that there’s a lot of inconsistency in how surgeons approach hiatal hernias during weight loss surgery. This inconsistency seems to be influenced by a variety of factors, including how often surgeons use different diagnostic tests, individual differences among surgeons, and differences between hospitals.

FAQs

  1. What is a hiatal hernia and how common is it among patients undergoing weight loss surgery?
  2. How consistent are methods of diagnosing and repairing hiatal hernias during weight loss surgeries?
  3. What factors contribute to the inconsistency in diagnosing and repairing hiatal hernias during weight loss surgeries?

Doctor’s Tip

A helpful tip a doctor might give a patient about hiatal hernia repair is to make sure to discuss the potential need for hernia repair with their surgeon before undergoing weight loss surgery. It’s important to ask about the surgeon’s approach to diagnosing and repairing hiatal hernias, and to understand the potential risks and benefits of hernia repair during surgery. By having an open and informed conversation with their surgeon, patients can make the best decision for their individual situation and ensure they receive appropriate care for their hiatal hernia.

Suitable For

Typically, patients who are experiencing symptoms related to their hiatal hernia, such as acid reflux, difficulty swallowing, chest pain, or regurgitation, are recommended for hiatal hernia repair. In some cases, patients with large hiatal hernias that are causing complications, such as stomach strangulation or Barrett’s esophagus, may also be recommended for surgery.

Additionally, patients undergoing weight loss surgery, such as gastric bypass or sleeve gastrectomy, may be recommended for hiatal hernia repair if a hiatal hernia is detected during preoperative testing or if the surgeon believes that repairing the hernia will improve outcomes or reduce the risk of complications during and after surgery.

Overall, the decision to recommend hiatal hernia repair will depend on the individual patient’s symptoms, the size and severity of the hernia, and the surgeon’s judgment based on their experience and the available evidence.

Timeline

Before hiatal hernia repair:

  1. Patient experiences symptoms such as heartburn, chest pain, difficulty swallowing, or regurgitation of food.
  2. Patient undergoes diagnostic tests such as an upper endoscopy, barium swallow, or esophageal manometry to confirm the presence of a hiatal hernia.
  3. Surgeon decides whether or not to repair the hiatal hernia during weight loss surgery based on their own criteria and the results of diagnostic tests.

After hiatal hernia repair:

  1. Patient undergoes weight loss surgery, such as gastric bypass or sleeve gastrectomy.
  2. If the hiatal hernia is repaired during surgery, the surgeon may use different techniques such as crural reinforcement or fundoplication to repair the hernia.
  3. Patient may experience a reduction in symptoms related to the hiatal hernia, such as improved heartburn or swallowing difficulties.

Overall, the timeline of a patient with a hiatal hernia before and after repair can vary significantly based on how the hernia is diagnosed and repaired by the surgeon. It’s important for surgeons to have a standardized approach to diagnosing and repairing hiatal hernias during weight loss surgery to ensure consistent outcomes for patients.

What to Ask Your Doctor

Here are some questions a patient should ask their doctor about hiatal hernia repair:

  1. How will you diagnose my hiatal hernia before surgery?
  2. What are the potential risks and complications of hiatal hernia repair surgery?
  3. What type of surgical approach will you use to repair my hiatal hernia?
  4. How experienced are you in performing hiatal hernia repair surgeries?
  5. What is the success rate of hiatal hernia repair surgery?
  6. How long is the recovery process after hiatal hernia repair surgery?
  7. Will I need to make any lifestyle changes after hiatal hernia repair surgery?
  8. How will you monitor my progress and follow up after the surgery?
  9. Are there any alternative treatment options for hiatal hernia repair?
  10. Can you provide me with more information or resources about hiatal hernias and their repair?

Reference

Authors: Valukas CS, Vitello D, Sanchez J, Soetikno A, Prinz J, Hungness ES, Teitelbaum EN. Journal: Surg Endosc. 2024 Sep;38(9):5017-5022. doi: 10.1007/s00464-024-11048-7. Epub 2024 Jul 12. PMID: 38997455