David Gutierrez Blanco, MD, Emanuele Lo Menzo, MD, PhD, Rama Ganga, MD, Samuel Szomstein, MD, Raul Rosenthal, MD. Cleveland Clinic Florida
Objective: To present a video of the laparoscopic reduction of an intrathoracic gastric pouch following roux en y gastric bypass and repair of a recurrent hiatal hernia following multiple prior repairs.
Case report: A 72-year-old female with a history of roux en y gastric bypass, complicated by a hiatal hernia with two prior hiatal hernia repairs, presents with high-grade dysphagia and weight loss due to a recurrent hiatal hernia and an intrathoracic herniated gastric pouch.
Technique: The abdominal cavity is accessed through the supraumbilical midline laparotomy with a Hasson technique. The left lobe of the liver and the spleen densely adhered to the stomach and these were meticulously dissected away. The right and left crus of the diaphragm were identified, the intrathoracic adhesions released, and the pouch reduced into the abdominal cavity. In doing so, a gastrotomy was created on the lesser curvature side of the pouch where it had completely adhered to the right crus. This was closed with a double layer of running 0 vicryl sutures. Once the gastric pouch and distal esophagus had been completely reduced into the abdomen, the diaphragmatic hiatus was closed with a running 2-0 prolene unidirectional barbed suture, both posteriorly and anteriorly. An air leak test was performed and a drain placed in the subhepatic space.
Conclusion: This video demonstrates the technique of laparoscopic reduction of an intrathoracic gastric pouch following roux en y gastric bypass and repair of a recurrent hiatal hernia following multiple prior repairs.
Teaching point: Systematic approach to re-do complex hiatal surgery is paramount to achieve good outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87720
Program Number: V157
Presentation Session: Bariatrics Videos Session
Presentation Type: Video