title: Does laparoscopic gastric banding create hiatal hernias?
abstract: BACKGROUND
  We hypothesized that laparoscopic adjustable gastric band (LAGB) placement might result in the development of a hiatal hernia (HH) over time. The objective of our study was to determine whether HHs develop after LAGB in the setting of a university hospital.
  
  
  METHODS
  We retrospectively reviewed all outcomes for consecutive LAGB patients in our institutional, longitudinal prospective bariatric surgical database to identify those patients without evidence of a HH at LAGB placement, who subsequently underwent delayed HH repair.
  
  
  RESULTS
  From 2005 to 2009, 695 gastric bands were implanted. Twelve patients (1.72%) were identified who had no radiographic or intraoperative evidence of a HH at LAGB placement and who subsequently underwent HH repair at re-exploration. Patients presented 18 ± 10 months after band placement. Of these patients, 75% presented with gastroesophageal reflux disease or food intolerance (50% with gastroesophageal reflux disease alone). Also, 2 presented with acute pain due to band slippage and 1 with chronic pain and vomiting. In 50% of the patients, revision procedures detected the HH at operation despite negative preoperative studies.
  
  
  CONCLUSIONS
  In our series, a significant HH developed in 1.7% of LAGB patients who had no clinically identifiable HH at LAGB placement. Persistent dysphagia after band deflation requires careful inspection of the hiatus during surgical revision, even in the absence of radiologic depiction of HH, and might represent an underlying etiology of LAGB dysfunction. This complication, along with esophageal dilation and annular pouch dilation, might represent a constellation of conditions with a common etiology. From the results of our small series, we raise the question of the existence of chronic backpressure created by LAGB restriction and accounting for these complications.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Dan E
authors.initials: DE
authors.lastname: Azagury
authors.forename: Oliver
authors.initials: O
authors.lastname: Varban
authors.forename: Ali
authors.initials: A
authors.lastname: Tavakkolizadeh
authors.forename: Malcolm K
authors.initials: MK
authors.lastname: Robinson
authors.forename: Ashley H
authors.initials: AH
authors.lastname: Vernon
authors.forename: David B
authors.initials: DB
authors.lastname: Lautz
mesh_terms: D005512:Food Hypersensitivity / Q000209:etiology; D005764:Gastroesophageal Reflux / Q000209:etiology; D015391:Gastroplasty / Q000009:adverse effects*; D006551:Hernia, Hiatal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D009767:Obesity, Morbid / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D015431:Weight Loss