The Results of Hiatal Hernia not Amended During Gastric Banding – A Case Report and the Conclusions Stemming from it

Introduction: Hiatal hernia is frequent in patients undergoing bariatric surgery [1].There is evidence that laparoscopic gastric banding is associated with deterioration of GERD, however, the treatment of a hiatal hernia accidentally discovered during a LGB is still under debate. We would like to use the current case report to shed some light upon the decision not to close a hiatal hernia discovered accidentally during Lap band, and its grave consequences. Patient description: A 36 old female, with a known LGB, was admitted to the Urology ward due to suspected nephrolithiasis and Left flank pain. Deterioration in her status and worsening of the LUQ pain has led to a CT with subsequent drain insertion due to a suspected effusion. A follow up CT showed the stomach in the left hemithorax, with the drain inserted in the upper border of the stomach. The patient was taken to the OR, and there a multidisciplinary team of general and cardiothoracic surgeons operated upon her. In the operation a left thoracotomy was done to enable the reduction of the stomach back to the abdomen and a thorough drainage of the left chest. After that, in a formal laparotomy a sleeve gastrectomy was done due to necrosis of the greater curvature. An esophagostomy was performed to enable diversion of esophageal content from the stomach. Discussion and conclusions: Many changes have occurred in thebariatric field since the 1990's when hiatal hernia was considered a contraindication for LAGB. But, a change of paradigm has occurred, and just like our patient has shown, not operating upon a hiatal hernia during LAGB is extremely dangerous for the patient. From this stems only one conclusion - If one encounters a hiatal band during a LAGB procedure, be it a primary or revisional one, one has to fix this defect or else endanger his patient unnecessarily