title: Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy.
abstract: BACKGROUND
  Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence.
  
  
  METHODS
  High-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative course.
  
  
  RESULTS
  Primary LSG was performed in 2417 patients. The overall prevalence of HH was 7.3%. Preoperative diagnosis of gastroesophageal reflux disease and female gender were independent risk factors for HH presence. Operative times were significantly longer when HH was concomitantly repaired but "foreknowledge" thereof did not assist in shortening this time. Looking for an HH that was suggested in preoperative upper gastrointestinal evaluation slightly prolonged surgery. LOS was not changed in a significant fashion by HH presence and repair, whether suspected or incidentally found.
  
  
  CONCLUSIONS
  Routine, pre-LSG barium swallow does not seem to offer an advantage over selective intraoperative hiatal exploration, in the discovery and management of HH. Conversely, when preoperative workup yields a false-positive result, surgery is slightly prolonged.
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel. Electronic address: david.goitein@sheba.health.gov.il.
authors.forename: David
authors.initials: D
authors.lastname: Goitein
authors.affiliation: Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel; Department of Surgery A, Emek Medical Center, Afula, affiliated with the Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Nasser
authors.initials: N
authors.lastname: Sakran
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Rayman
authors.affiliation: Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Szold
authors.affiliation: Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Goitein
authors.affiliation: Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.
authors.forename: Asnat
authors.initials: A
authors.lastname: Raziel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods; D001464:Barium; D003287:Contrast Media; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications; D006551:Hernia, Hiatal / Q000175:diagnosis* / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D019564:Unnecessary Procedures; D055815:Young Adult
chemical_list: D003287:Contrast Media; D001464:Barium
keywords: Barium swallow; Diaphragmatic hernia; Hiatal hernia; Paraesophageal hernia; Sleeve gastrectomy