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Repair of Post-Bariatric, Recurrent and De-Novo Hiatal Hernias Improves Bloating, Abdominal Pain, Regurgitation, and Food Intolerance (BARF)

Highlights•Post-bariatric hiatal hernias can cause a cluster of symptoms (BARF: Bloating, Abdominal Pain, Regurgitation, and Food Intolerance) that incorrectly attributed to eating behaviors•Review of diagnostic studies by bariatric surgeons yields significant insight to whether BARF symptoms are related de-novo or recurrent hiatal hernias•Repair of post-bariatric hiatal hernias improves BARF symptoms in most patients however, reflux or heartburn persisted in 56% of patients•Classification of post-bariatric hiatal hernias to Type I or II facilitates reporting of outcomesAbstractBackgroundPost-bariatric hiatal hernias are associated with a cluster of symptoms including Bloating (nausea/vomiting or fullness), Abdominal pain, Regurgitation, and Food intolerance or dysphagia (BARF).Objectiveto report the short-term outcomes of repairing post-bariatric hiatal hernias and improvement of BARF.SettingLarge multispecialty group practice with university affiliationMethodsWe reviewed the records of all consecutive patients who underwent repair of post-bariatric hiatal hernias (2012-20). Data are mean±SD (standard deviation).ResultsWe repaired hiatal hernias in 52 patients (age: 57±10yr), 4±3 years post sleeve gastrectomy (SG; n=27), 11±6 years post Roux-en-Y gastric bypass (RYGB; n=24) and 11 years post duodenal switch with SG (DS; n=1). Diagnosis was made by upper gastrointestinal contrast study (80%), computed tomography (70%) and/or endoscopy (56%). Hernias in patients with SG were repaired by a posterior cruroplasty after reducing the neo-stomach into the abdomen (n=11 and n=1 DS) or converting the SG to RYGB (n=16). All 24 RYGB patients underwent hernia repair similarly. At 12±10 months follow-up, dysphagia or regurgitation improved in >80% of patients while nausea, vomiting or abdominal pain improved in 70% of patients; heartburn persisted in 56% of patients. Three patients developed subsequent recurrent hernias that required operative repair.ConclusionsHiatal hernias containing the neo-stomach present earlier after SG than RYGB. The diagnosis can be made with a combination of imaging studies and endoscopy. Repair of post-bariatric hiatal hernias markedly improves symptoms of BARF in most patients.


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