Fixation of the Esophagus to Diaphragmatic Hiatus as a Routine Step in Hiatal Hernia Repair During Bariatric Surgery:...

This approach aims to reduce postoperative intrathoracic migration (ITM) of the esophagus and upper gastric tube, decreasing the recurrence of hiatal hernia (HH) and the development of "de novo" HH after Hiatal hernia repair (HHR) if indicated in bariatric surgery, especially laparoscopic sleeve gastrectomy (LSG).

In performing LSG, HHR is conducted if indicated based on involving both pre-operative and intra-operative evaluations. Following this, our innovative technique is applied, which involves esophageal fixation to the diaphragmatic hiatus after a complete dissection of the phreno-esophageal membrane to free the full length of the intra-abdominal esophagus. This is accomplished through two distinct methodologies: interrupted suture fixation and continuous suture fixation using a 2/0 Ti-Cron^TM suture over a 26-mm round needle, both commonly used in HHR. These techniques are comprehensively described in the accompanying video.

All patients are discharged from the hospital the next day and followed up at the clinic after the end of the first and second weeks, then after 3, 6, and 12 months postoperatively.

Combining esophageal fixation with HHR during LSG is assumed to reduce ITM and the possibility of HH recurrence, improving patient quality of life.