Background

We are presenting a case of early re-herniation of the upper portion of a sleeve gastrectomy in the early post-operative period. Our patient is a 37-year-old female with history of obesity (BMI 38.3) and multiple prior surgeries including umbilical hernia repair with intraperitoneal mesh and abdominoplasty. Pre-operative EGD demonstrated a hiatal hernia and no evidence of esophagitis. Given dense adhesions, intra-operative decision was made to proceed with a robotic sleeve gastrectomy with hiatal hernia repair. She initially tolerated PO following surgery, but experienced an episode of forceful emesis POD0 with subsequent intolerance of sips of water. Initial workup was concerning for too tight of a hernia repair, for which she underwent EGD with dilation. Shortly after, she had recurrent symptoms of PO intolerance and a CT demonstrated herniation of her sleeve into the chest. She was brought back to the OR on POD4 for revision of the hiatal hernia repair, reduction of the stomach, and omentopexy. The stomach appeared viable at the portion that had been incarcerated. Slight angulation at the incisura was noted on EGD which was corrected with omentopexy at the distal staple line. Immediately following surgery she was able to tolerate PO and was discharged home post-operative day 2.