Question of the Month

Lauren sent us this question few days ago:

“I had gastric sleeve surgery in June 2015. I recently had an unrelated x-ray of my back and found out I have a hiatal hernia. I had heard before the surgery and after. Could the surgery have caused the hernia? Is there anything I should do about it? Also, I had 80 pounds to lose and only lost 50 in 1.5 years. My stomach has stretched a little. What should I do to lose the weight? Thank you”

Thank you, Lauren, for your important and interesting question. Hiatal hernias and acid reflux are very common in overweight individuals. At Houston Weight Loss Surgery Center, we carefully investigate the hiatal area before and during gastric sleeve surgery to make sure we address the issue. It is important to properly fix a hiatal hernia during gastric sleeve surgery for several reasons. First, by dissecting the hiatal hernia, the gastric fundus is completely free of surrounding adhesions. A completely mobilized gastric fundus is crucial to ensure proper sleeve resection. Incomplete fundus resection leads to poor weight loss and post-operative acid reflux. Second, a hiatal hernia in the setting of gastric sleeve surgery leads to acid reflux disease as well as bile gastritis. Two conditions that cause significant pain and discomfort after surgery. Third, if the hiatal hernia is not fixed during gastric sleeve surgery, then the sleeved stomach will tend to migrate into the chest with time. Such a condition will further exacerbate acid reflux, difficulty swallowing food, and bile reflux.

Does gastric sleeve surgery by itself cause a hiatal hernia? The answer is No. However, if the hiatus is partially dissected during gastric sleeve surgery to fix a hiatal hernia or for other reasons then you are put at risk for hiatal hernia development with time.

Is there anything I should do about it? If you are not experiencing heartburn, food regurgitation, pain, nausea… then there is no need to repair the hernia. I would recommend an upper endoscopy to evaluate the distal esophagus for distal esophagitis, and the stomach for bile gastritis. Upper endoscopy is a more sensitive test than X-ray to evaluate a hiatal hernia.

Regarding your weight loss, many factors contribute to poor weight loss after gastric sleeve surgery. I strongly recommend you follow up with your bariatric surgeon to explore the reasons behind your poor weight loss. In certain cases, gastric sleeve revision or conversion to gastric bypass is recommended.

Warm regards,

Dr. Darido