Patients commonly complain of dysphagia following sleeve gastrectomy. Common causes for this include antral stunning, underlying medical conditions, narrowing of the gastric sleeve due to sharp angulation or spiralling and a reaction to anaesthesia.
We present an unusual case of a 57-year-old lady with BMI of 37 who underwent a primary sleeve gastrectomy and hiatus hernia repair. The patient was well post-operatively and was discharged day 2 post op. However, she was re-admitted 2 weeks later with acute dysphagia to solids with vomiting.
We performed a barium meal which demonstrated a kinked narrowed proximal end of the sleeve with acute herniation into the chest. Laparoscopy revealed herniation of the proximal part of the sleeve above the diaphragm due to giving way of the anterior crural stitches. The sleeve was pulled back into the abdominal cavity and the intra-abdominal length of the esophagus was confirmed. The left and right crura were further approximated using sutures and the sleeve was anchored at the angle of His to the diaphragm. The patient’s symptoms resolved and she was discharged safely.
Acute sleeve herniation should be considered as a cause of dysphagia post sleeve gastrectomy. Barium studies and early repeat laparoscopy are essential for managing this complication.