Matthew L Dong, MD, MPH, Desmond Huynh, Daniel Herron, MD, FACS. Icahn School of Medicine at Mount Sinai
Introduction: The patient in this video submission is a 43 year old male who presented with a chief complaint of dysphagia. He had a history of sleeve gastrectomy five years prior to his presentation with good weight loss. He was found to have a hiatal hernia containing much of his gastric sleeve and Barrett’s esophagus without dysplasia on endoscopy.
Methods and Procedures: In this video, we demonstrate repair of a hiatal hernia in a patient with a prior history of laparoscopic sleeve gastrectomy, with crural repair and conversion of his sleeve to a gastric bypass. The patient’s postoperative course was complicated by an immediate recurrence, which was managed with revision of his hiatal repair and placement of pexy sutures.
Results: Following revision of his repair, patient was discharged on the day after his second surgery after an uneventful recovery. At his two week follow-up, he was asymptomatic and recovering well.
Conclusion: This case demonstrates appropriate management of immediate postoperative recurrence of a hiatal hernia with immediate reoperation. It highlights the importance of extensive mobilization of the esophagus when repairing hiatal hernias, particularly in revisional surgeries. Finally, we would argue that consideration should be given to pexy sutures when converting a sleeve to a bypass with concomitant hiatal hernia and that this case underscores the importance of routine postoperative upper gastrointestinal series imaging.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79202
Program Number: V035
Presentation Session: Thursday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo