Background

Hiatal hernia after gastric bypass is a serious problem that is difficult to manage. There have been instances of surgeons using the remnant stomach to create a fundoplication around the gastric pouch to treat hiatal hernias. In this video, we demonstrate a patient's hiatal hernia recurrence after a toupet fundoplication of a gastric pouch. We perform a mediastinal dissection to reduce the herniated fundoplication and gastric pouch, takedown the fundoplication, perform a hiatal hernia repair utilizing fixation of the esophagus and pouch, and resect the battered portion of remnant stomach. Hiatal hernia after bariatric surgery is a difficult situation that we believe can be treated without fundoplication.