Routine Upper Gastrointestinal Fluoroscopy Before Laparoscopic Sleeve Gastrectomy: Is It Necessary?

Area of Science:

• Bariatric Surgery
• Gastrointestinal Imaging
• Surgical Outcomes

Background:

• Controversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbidly obese patients undergoing laparoscopic sleeve gastrectomy (LSG).
• Hiatal hernias (HH) are a common finding in this patient population.

Purpose of the Study:

• To determine the efficacy of routine preoperative upper GI fluoroscopy in detecting hiatal hernias (HH) in patients undergoing LSG.
• To evaluate the impact of HH detection and repair on operative time and complication rates.

Main Methods:

• Retrospective query of a prospectively maintained, IRB-approved database of patients who underwent LSG between 2011 and 2017.
• Review of preoperative upper GI fluoroscopy reports and comparison with intraoperative findings of HH.
• Statistical analysis of sensitivity, specificity, operative times, and complication rates.

Main Results:

• The overall prevalence of HH was 11.1%.
• Preoperative upper GI fluoroscopy demonstrated a sensitivity of 32% and specificity of 94% for HH detection.
• Concomitant LSG and HH repair significantly increased operative time (76 min vs. 55 min, p < 0.001), but foreknowledge of HH did not influence operative duration.
• HH repair did not significantly affect the complication rate (p = 0.3).

Conclusions:

• Routine preoperative upper GI fluoroscopy has low sensitivity for detecting hiatal hernias in patients undergoing LSG.
• Health policy regulators should consider omitting this exam from routine preoperative evaluations for bariatric surgery patients.