Background
Sleeve stenosis or angulation is a well-known complication of sleeve gastrectomy, and conversion to Roux-en-Y gastric bypass (RYGB) is the usual option for management. We describe an alternate approach in a patient with hiatal hernia.
Methods
A 57-year-old female with sleeve gastrectomy 4 months prior presented for a second opinion with persistent and worsening nausea, emesis and abdominal pain after oral intake and with TPN dependence. Upper GI studies and upper endoscopy confirmed hiatal hernia and sleeve stricturing/angulation. Given a history of prior steroid use and irritable bowel syndrome, she wished to avoid a gastric bypass with its potential risk for marginal ulcers and dumping syndrome. A hiatal hernia repair was conducted and then stricturoplasty was first attempted, but sleeve angulation persisted, so a gastro-gastrostomy was performed with straightening of her sleeve. She recovered unremarkably and was able to advance her diet and stop TPN.
Conclusions
For sleeve stenosis, stricturoplasty and gastro-gastrostomy are viable alternatives to conversion to bypass. Bariatric surgeons should have these options in their armamentarium for patients not amenable to conversion to bypass.