Gastric Herniation following Laparoscopic Sleeve Gastrectomy: a Rare Acute Complication

Gastroesophageal Reflux Disease (GERD) and Hiatal Hernia (HH) are known comorbidities of morbid obesity, with an incidence of 50% and 15% respectively in patient with Body Mass Index (BMI) > 35 Kg/m2. Laparoscopic Sleeve Gastrectomy (LSG) was initially intended as the first step of the bilio-pancreatic diversion with duodenal switch, in super-super obese patients, but it is now considered as an alternative to Laparoscopic Roux-en-Y gastric by-pass (LRYGB) as stand-alone treatment of morbid obesity. The indications for LSG are similar to those for LRYGB, although some authors consider GERD, with or without HH, a relative contraindication for LSG as some reports showed an increase in GERD symptoms in up to 20% of patients and new onset symptoms in 18% of cases after LSG [1]. Closure of the hiatal defect in case of an intraoperative finding of HH can be unsuccessful considering that the narrow gastric sleeve is more prone to herniate into the chest even after hiatal repair. We present a case of acute post-operative dysphagia due to herniation and kinking of the sleeved stomach into the posterior mediastinum which was treated with reduction of the herniated stomach in the abdomen and conversion to LRYGB. To the best of our knowledge this is the second report of such complication described in the literature, and the first in which conversion to a by-pass has been described.