Should You Check for Hiatal Hernia before Sleeve Gastrectomy?

Should You Check for Hiatal Hernia before Sleeve Gastrectomy?

Kate from Houston sent us this question: “Do you guys offer testing for hiatal hernias? I’ve been considering gastric sleeve surgery, but I have severe heartburn and food regurgitation. Was thinking if I do have a hiatal hernia, might as well do both surgeries at once”.

Dear Kate,

Hiatal hernia testing and repair is an integral part of gastric sleeve surgery. Hiatal hernia is a defect in the opening in the breathing muscle through which the stomach herniates into the chest. Hiatal hernia repair restores normal anatomy by reducing the stomach back into the chest and closing the hernia defect. Keeping part of the stomach in the chest especially after sleeve gastrectomy results in severe acid reflux. Gastric sleeve has low compliance and readily responds to negative chest pressure. Negative pressure transmitted into gastric lumen results in a plunger like effect: acid and bile are aspirated into the upper part of the sleeve and distal esophagus where there is negative pressure. The effect is reproduced with the smallest hiatal hernias necessitating repair of any size hiatal hernia during sleeve gastrectomy. Since acid reflux and hiatal hernias are prevalent in the obese patient population careful testing for hiatal hernias prior to gastric sleeve surgery is routinely performed at Houston Weight Loss Surgery Center. Testing is performed using upper endoscopy. Additional tests like ambulatory pH testing and esophageal manometry are added if needed. Using this approach, we have prevented new onset acid reflux after sleeve gastrectomy and cured pre-existing acid reflux with proper hiatal hernia repair and gastric sleeve surgery.

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