title: Radiographic predictability of hiatal hernia prior to gastric band surgery.
abstract: BACKGROUND
  Hiatal hernia (HH) is closely associated with morbid obesity. There is controversy over the need for preoperative imaging before laparoscopic adjustable gastric band placement. The aim of this study is to determine the predictive value of preoperatively diagnosing HH with upper gastrointestinal (UGI) series imaging.
  
  
  METHODS
  A retrospective review of a single surgeon's experience with laparoscopic adjustable gastric band placements was performed. All patients received a preoperative UGI series. The decision to perform an HH repair at the time of gastric banding was based on intraoperative findings. Each patient's UGI study was compared with the operative report. Patients' outpatient records were also reviewed for subjective reflux symptoms or use of antireflux medications.
  
  
  RESULTS
  Of 146 patients, 63 (43%) had intraoperative findings consistent with an HH and underwent repair. Of these, only 32 (50%) had a preoperative UGI study that showed an HH (positive predictive value, 50%). Of the 83 patients who did not have an intraoperative HH, only 51 (61%) had a congruent UGI (negative predictive value, 62%). No correlation was found between patient-reported symptoms and either radiologic or intraoperative findings.
  
  
  CONCLUSIONS
  UGI series have poor positive and negative predictive values in preoperatively diagnosing HH. In addition, subjective patient symptoms and the need for antireflux medication did not correlate with either radiologic or intraoperative findings of HH. Our results suggest that direct operative diagnosis is a more accurate method of detecting HH.
authors: Rush University Medical Center, Chicago, IL, USA.
authors: Joseph R
authors: JR
authors: Broucek
authors: Rush University Medical Center, Chicago, IL, USA.
authors: Lane A
authors: LA
authors: Ritter
authors: Rush University Medical Center, Chicago, IL, USA.
authors: Amanda B
authors: AB
authors: Francescatti
authors: Rush University Medical Center, Chicago, IL, USA.
authors: Claire H
authors: CH
authors: Smith
authors: Rush University Medical Center, Chicago, IL, USA.
authors: Minh B
authors: MB
authors: Luu
authors: Rush University Medical Center, Chicago, IL, USA.
authors: Khristi M
authors: KM
authors: Autajay
authors: Rush University Medical Center, Chicago, IL, USA; Rush University Medical Center, 1725 W Harrison St, Ste 810, Chicago, IL 60612, USA. jonathan_a_myers@rush.edu.
authors: Jonathan A
authors: JA
authors: Myers
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011860:Radiography, Abdominal / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult