Background

Screening upper endoscopy is often performed prior to bariatric surgery; however, the accuracy of both endoscopic and intraoperative detection of hiatal hernia is uncertain. We examined the concordance between preoperative endoscopy findings and the performance of concurrent hiatal hernia repair during bariatric surgery.

Methods

This is a multi-center retrospective cohort study from 2017-2023. Adults undergoing sleeve gastrectomy or Roux-en-Y gastric bypass who also had a pre-operative endoscopy were included. Concordance was defined as a match between the presence or absence of hiatal hernia on pre-operative endoscopy and whether a hiatal hernia repair was performed during the patient's bariatric surgery. Univariable and multivariable logistic regression were performed for concordance, with patient and operative factors as covariates.

Results

1,373 patients matched inclusion criteria. 74.2% of patients had concordance between their pre-operative endoscopy and surgical procedure (12.5% hiatal hernia found on both, 61.8% no hiatal hernia on either), while 25.7% had discordance. Hiatal hernias detected on pre-operative endoscopy were more likely to be repaired when the pre-operative endoscopy was performed by a surgeon compared to gastroenterologists (69.0% vs 56.3%, p=0.01). After controlling for confounders, factors associated with positive concordance between pre-operative endoscopy and surgery included female gender (OR 2.22, p<0.01), GERD (OR 3.22, p<0.01), and surgeon as endoscopist (4.67, p<0.01).

Conclusions

In this series, discordance between the diagnosis of hiatal hernia at the time of pre-operative endoscopy and surgery was 25%. Factors associated with concordance of endoscopic and intraoperative findings included female gender, history of GERD, and surgeon as endoscopist.