Background

Hiatal hernia post-sleeve can be managed in several ways. Literature have shown that revisional surgery to Roux-en-Y gastric bypass my yield better outcomes. Anatomy related contraindications to such procedure are limited and controversial. For example; short bowel length, hernia-containing bowel, and bowel injury. Intraoperative intestinal adhesions can as well be a concern. Due to the controversial approaches in hiatal hernia post sleeve; doing hernia repair alone in the discovery of intestinal adhesion might be attempted. However; having view on those cases and how to navigate such challenge can improve our surgical experience and decision in the future; where optimal outcomes can be achieved.

Methods

A 30 Years-old female medically free patient presented to the clinic for reflux symptoms. Patient gave surgical history of congenital diaphragmatic hernia repaired at birth, open appendectomy, and sleeve gastrectomy done 4 years before presentation. BMI was 44 and she lost around 45Kgs post-sleeve. Patient gave history of acid and food reflux, not improving with diet modification nor medications. Upper gastro-intestinal series showed hiatal hernia and contrast reflux. Esophagogastroduodenoscopy showed hiatal hernia yet no inflammatory changes related reflux. Lastly; computed tomography showed large mixed hiatal hernia. Multidisplinary meeting was done; planned for revisional surgery of Roux-en-Y gastric bypass and hiatal hernia repair.

Conclusions

Extensive intestinal adhesions can be faced during Roux-en-Y gastric bypass, which might lead to aborting the surgery; however, trial of meticulous adhesiolysis and completion of the procedure can be attempted resulting in successful outcomes as in the present case