Hiatal Hernia Evaluation Before Bariatric Surgery: Should It Be Routinely Done?

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Diagnostic Imaging

Background:

• Hiatal hernia (HH) diagnosis in bariatric surgery candidates is often incidental during surgery.
• The necessity of routine preoperative esophagogastroduodenoscopy (EGD) and upper gastrointestinal series (UGIS) for HH evaluation is debated.

Purpose of the Study:

• To determine the diagnostic accuracy of preoperative EGD and UGIS for hiatal hernia in patients undergoing bariatric surgery.
• To assess the positive and negative predictive values of these imaging modalities.

Main Methods:

• Retrospective review of 463 bariatric surgery patients (2011-2015).
• Analysis of routine preoperative UGIS and/or EGD findings compared to intraoperative diagnoses.
• Calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Main Results:

• Hiatal hernia was found intraoperatively in 11.4% of patients.
• EGD showed higher sensitivity (47.4%) than UGIS (30.2%), but lower specificity (81.4% vs. 97.5%).
• Combined sensitivity of both tests reached 60.5%; PPV and NPV varied significantly.

Conclusions:

• Both EGD and UGIS demonstrate low sensitivity for preoperative hiatal hernia diagnosis.
• These routine preoperative imaging tests may be omitted for most bariatric surgery candidates.
• Consideration for high-risk patients with specific symptoms or history is advised.