Special Issue Introduction
As we know, laparoscopic sleeve gastrectomy (LSG) at present is the most frequent bariatric procedure for morbid obese patients. An extensive discussion has been carried out due to the worsening or di novo reflux symptoms, esophagitis, or hiatal hernia after the procedure. The controversies have focused on the indication of sleeve gastrectomy in patients with reflux or hiatal hernia otherwise to add some type of prevention procedure to avoid this troublesome. Therefore, many surgeons suggest excluding patients with this condition as candidate to LSG and prefer to indicate gastric bypass. In addition, several procedures have been proposed to treat or prevent gastroesophageal reflux and hiatal hernia.
In this sense, even now we still have some questions with no definitive answer. For instance, some of them are:
- Which is the best algorithm for evaluating whether the laparocsopic sleeve gastrectomy is suitable for patient candidates with suspected reflux or hiatal hernia? Is manometry or reflux assessment always necessary?
- How to define the presence of hiatal hernia, before or during laparoscopic exploration?
- Should patients with confirmed hiatal hernia be excluded for LSG? Or indicated LSG with concomitant hiatal hernia repair? What would be the results when we choose LSG?
- Which is the role of combined procedure during sleeve adding mini Nissen, Dor, Gastropexy or procedure to diminish intragastric pressure, simultaneous repair?
- Which surgical maneuver is the better approach to close the hiatus? Anterior or posterior approach? By the right or left approach? Mesh?
- Several procedures such as hiatal hernia repair with or without closure of the hiatus or adding antireflux procedure have been proposed.
- How to evaluate objectively the postoperative results? Which are the published data?
- Which are the results at long-term follow-up？
- Is it better to offer gastric bypass as the primary procedure or LSG with hiatal hernia as primary operation?
Therefore, there are many questions to answer and discuss in this special issue.
We have invited international experts to help us to discuss and elucidate these questions to have an updated information.
Emanuele Soricell, Santa Maria Nuova Hospital, Firenze, Italy
Marco Aurelio Santo, Universidade de Sao Paulo, Sao Paulo, Brazil
Pablo E. Omelanczuk, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Angelo Iossa, Università degli Studi di Roma La Sapienza, Rome, Italy
Gianfranco Silecchia, Università degli Studi di Roma La Sapienza, Rome, Italy
Antonio J. Torres, Universidad Complutense de Madrid, Madrid, Spain
Sergio Santoro, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Giacomo Piatto, San Valentino Hospital, Rome, Italy
Luigi Angrisani, Università degli Studi di Napoli Federico II, Napoli, Italy
The list is arranged in no particular order and to be updated.