Intrathoracic Pouch Migration in One-Anastomosis Gastric Bypass with and without Hiatoplasty – A 3D-CT Volumetry Study


Currently, 4.8% of bariatric operations worldwide are One-Anastomosis Gastric Bypass
(OAGB) procedures. If a hiatal hernia is detected in a preoperative gastroscopy, OAGB
can be combined with hiatoplasty. Intrathoracic pouch migration (ITM) is common after
bypass procedures because the fundus, a natural abutment, is separated from the pouch.The
aim of this study is to find out whether OAGB or OAGB combined with hiatoplasty carries
a higher risk of ITM and therefore also gastro-esophageal reflux disease (GERD).


University hospital


Fifty patients (group 1: 25x primary OAGB; group 2: 25x primary OAGB with hiatoplasty)
were included in this study. History of weight, GERD, and quality of life were recorded
in patient interviews and pouch volume and ITM were evaluated using 3D-CT volumetry


There were no differences in terms of patient characteristics, history of weight,
pouch volume or quality of life between both groups. ITM was found in group 1 in 60%
(n=15) and group 2 in 76% (n=19) of all patients (p=0.152). The ITM mean length was
significantly lower in group 1 with 0.9 ±1.1cm than in group 2 with 1.8 ±1.2cm (p=0.007).
Regarding GERD, there was no difference between both groups, nevertheless, significantly
more patients with ITM (38.2%; n=13) were suffering from GERD compared to patients
without ITM (6.3%; n=1).


In primary OAGB, an additional hiatoplasty was not associated with higher rates of
ITM or GERD, nevertheless the length of ITM was higher after hiatoplasty. If ITM occurs,
patients have a risk developing GERD.

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