Background

Patient is a 51-year-old female with a history of gastroesophageal reflux disease, previous laparoscopic hiatal hernia repair with mesh and Nissen fundoplication in 2012, and subsequent recurrent hiatal hernia repair with mesh explantation, conversion of Nissen to Toupet fundoplication and gastrostomy tube placement in 2020. She presented to our clinic with recurrent reflux symptoms, difficulty with oral intake and weight loss. Pre-operative esophagogastroduodenoscopy revealed a 4cm recurrent hiatal hernia, with an intact wrap but with evidence of bile reflux. The patient was taken to the operating room for a robotic assisted laparoscopic Roux-en-Y gastric bypass. Unfortunately the orogastric tube was transected during the creation of the gastric pouch. This video demonstrates the management of this complication with partial resection of the gastric remnant, resection of the gastric pouch, and reconstruction with a hand-sewn esophagojejunostomy. The patient had an uneventful recovery, was discharged on postoperative day 3 and was last seen 11 months post-op doing well.