ABSTRACT
Background and aim: Hiatal Hernia (HH) is a common condition in obese patients undergoing bariatric surgery (BS). HH can be preoperatively diagnosed by upper GI endoscopy and it may influence the operation strategy. AIM: to assess the diagnostic accuracy of endoscopic HH detection, in comparison to intraoperative diagnosis assumed as a standard of reference. Materials and methods: A retrospective analysis was performed on a prospective database of consecutive patients who underwent bariatric surgery after the first peak of Covid-19 pandemic from May 2020 to February 2021 in a single bariatric center. All included patients underwent a preoperative gastroscopy by the same dedicated endoscopist (RP). All the surgical procedures have been performed by a single surgeon (LA). In case of intraoperative finding of HH, it was repaired contextually by performing a posterior cruroplasty. HH was defined as a distance between the gastro-esophageal junction and the diaphragmatic hiatus ≥2 cm and using Hill's classification (Hill grade III-IV). The intraoperative finding was assumed as gold standard for the HH diagnosis. Results: 247 patients underwent BS from May 2020 to February 2021. HH was intraoperatively diagnosed and repaired (HHR) in 118/247 patients (47,7%). The distribution of the surgical procedures is represented in Table 1. When compared to intraoperative evaluation, the sensitivity of the UGIE was 65% and the specificity 97%, with a positive predictive value of 96% and a negative predictive value of 74%. The preoperative diagnostic accuracy of UGIE was 81%.(table presented) Conclusions: Hiatal hernia is a common condition in obese population possibly understimated by the bariatric community. UGIE when performed by a dedicated endoscopist has a high accuracy of HH detection assuming the intraoperative diagnosis as reference standard.