Fixation of the Esophagus to Diaphragmatic Hiatus as a Routine Step in Hiatal Hernia Repair During Bariatric Surgery: How to do it? A Multimedia Article
Year: 2025
Type: article
Abstract: Introduction This approach aims to reduce postoperative intrathoracic migration (ITM) of the esophagus and upper gastric tube, decreasing the recurrence of hiatal hernia (HH) and the development of “de novo” HH after Hiatal hernia repair (HHR) if indicated in bariatric surgery, especially laparoscopic sleeve gastrectomy (LSG). Methods In performing LSG, HHR is conducted if indicated based on involving both pre-operative and intra-operative evaluations. Following this, our innovative technique is applied, which involves esophageal fixation to the diaphragmatic hiatus after a complete dissection of the phreno-esophageal membrane to free the full length of the intra-abdominal esophagus. This is accomplished through two distinct methodologies: interrupted suture fixation and continuous suture fixation using a 2/0 Ti-CronTM suture over a 26-mm round needle, both commonly used in HHR. These techniques are comprehensively described in the accompanying video. Results All patients are discharged from the hospital the next day and followed up at the clinic after the end of the first and second weeks, then after 3, 6, and 12 months postoperatively. Conclusion Combining esophageal fixation with HHR during LSG is assumed to reduce ITM and the possibility of HH recurrence, improving patient quality of life.
Source: Obesity Surgery
Authors: Emad Abdallah, Ibrahim Saleh Alawadi
Institutions: Mansoura University, Mansoura University Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,590
OpenAlex ID: W4409424676