Important Info on Hiatal Hernias the Band effectiveness and "slip" like issues

thought I would share...

Identifying a Hiatal Hernia
 

Repair of hiatal hernia during LAP-BAND® System surgery is becoming more common, largely because it has been found that as many as 50% of bariatric surgery patients have hiatal hernias

There are many reasons to consider concurrent repair of hiatal hernia during LAP-BAND® System surgery:

Emerging data suggest a decrease in revisions, it can be cost and time efficient to repair the hernia while the patient is anesthetized and the surgeon is already operating.

If the hernia is not repaired, the LAP-BAND® System might slide up and down in the chest, create "slip-like" symptoms, and impede weight loss progress

If the hernia is not repaired and abdominal fat is lost, the hernia may be responsible for poor weight loss
Scarring from the dissection may help keep the band in place and prevent band slippage.

Intraoperative identification is more accurate than preoperative upper GI and EGD assessments and is generally preferred for all preoperative symptomatic hernias. Many asymptomatic hiatal hernias are identified during surgery because the hernia can be seen.
 

The following list includes ways to intra operatively identify a hiatal hernia.

Actively search for the hiatal hernia and dissect it out.

Look for peritoneal reflection down onto esophagus and large crural defect on subsequent dissection

Look for lipomas plugging the hiatus, especially in large men.

While hiatal hernia repair during LAP-BAND® System surgery is becoming more commonplace, a surgeon may decide against repairing a hiatal hernia because:

Dissection to rule out a hiatal hernia can add time and complexity to the procedure.
The dissection may result in a higher slip rate.
The benefits of repair depend on the size of the hiatal hernia.

Warning: a large hiatal hernia may prevent accurate positioning of the device. Placement of the band should be considered on the case-by-case basis depending on the severity of the hernia.
 

REFERENCES

Dolan K, Finch R, Fielding G. Laparoscopic gastric banding and crural repair in the obese patient with a hiatal hernia. Obes Surg. 2003;13:772-775.



http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--images.ingentaselect.com-images-linkout-ingentaconnect.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3152&itool=Abstract-def&uid=10484300&db=pubmed&url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0960-8923&volume=9&issue=4&spage=396&aulast=Angrisani)
Treatment of morbid obesity and gastroesophageal reflux with hiatal hernia by Lap-Band.