Laparoscopic management of gastric bypass pouch stricture after paraesophageal hernia repair with mesh

Pablo Marin, MD, Miguel Lamota, MD, Abraham Betancourt, MD, Carolina Ampudia, MD, Abraham Abdemur, MD, Emanuele Lo Menzo, MD, Samuel Szmostein, MD, Raul Rosenthal, MD

Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida

Introduction: Laparoscopic paraesophageal hernia repair (LPEHR) is associated with a high recurrence rate. Repair with mesh lowers recurrence but can cause dysphagia and erosion.
Materials and Methods: A 55-year-old female presented to our clinic with epigastric abdominal pain and vomiting after laparoscopic Roux-en -Y gastric bypass and paraesophageal hernia repair with non-absorbable mesh in 2005. Preoperative UGI and EGD study showed a stricture in the gastric pouch at the hiatus. The patient underwent to a laparoscopic revision surgery. The intraoperative findings included a large recurrent paraesophageal hernia with dense adhesions with the mesh. The recurrent hernia was reduced and the defect closed with running knotless suture (Quill™). Intraoperative endoscopy showed complete patency of the pouch.
Result: The operative time was 65 minutes, with an estimated blood loss of 50 ml. The recovery of the patient was uneventful. The length of stay was 3 days. Patient is asymptomatic after 3 months of follow up.
Conclusion: The current data tend to support the use of prosthetic materials for hiatal repair in large PEHs, however the mesh can produce erosion and stricture. Revisional bariatric surgery is safer when is performed in a high volume center, where the surgeons have the technical skills, knowledge, and experience.

Session: Video Channel Day 1

Program Number: V054