Gastric herniation following laparoscopic sleeve gastrectomy is a surgical complication presented in up to 37% of cases in some studies. The intrathoracic migration of the stomachcan happen as early as 1 month after surgery.
We present a case of a 70 years old female who underwent sleeve gastrectomy in 2017 and 10 months later started with intermittent episodes of emesis without nausea. A CT scan of the chest showed a hiatal hernia and an upper GI series revealed a stricture at the herniated stomach with significant reflux into the esophagus. During surgery, a herniated and kinked stomach into the lower mediastinum was found. Once the herniated content was reduced, the hiatal defect was closed with barbed suture. Then, the fundus of the stomach was fixed to the left diaphragm crus.
The patient tolerated the procedure well with minimal blood loss. The patient was discharged home on post-operative day 2. She remains asymptomatic at her follow up visit.
Gastric herniation is a complication than can occur in more than one third of cases after sleeve gastrectomy . Moreover 40% of these patients may present reflux symptoms and the hiatal hernia correction is then indicated. Laparoscopic repair is feasible and safe.