Acute Intrathoracic Migration With Incarceration of Laparoscopic Sleeve Gastrectomy Due to Incomplete Hiatal Hernia Repair

Concomitant hiatal hernia repair during laparoscopic sleeve gastrectomy (LSG) is recommended if it is detected. Intrathoracic sleeve migration (ITSM) is a sliding hiatal hernia that develops after LSG. In this article, we present an early ITSM due to an incomplete repair of a hiatal hernia. An obese patient had hiatal hernia in the preoperative endoscopy. After LSG, the defect was repaired with anterior cruroplasty. Vomiting attacks were observed after the operation. Based on clinical signs and radiological findings, laparoscopic exploration was indicated. During the reoperation, an acute entrapment of the upper portion of the sleeve was observed, which had migrated through the hiatus. This suture was undone. There was no gastric ischemia. No additional hiatal repair was attempted. The operation was sufficient to alleviate the symptoms. The patient was discharged on the second postoperative day uneventfully. Until the most recent follow-up, the patient has progressed with adequate weight loss, without complaints of reflux and without proton pump inhibitors ITSM with incarceration is a complication that can occur after incomplete hiatal repair. Failure to perform hiatal repair with proper technique can be attributed to this complication.

Automated summary

This article presents a case of early intrathoracic sleeve migration (ITSM) due to incomplete repair of a hiatal hernia during laparoscopic sleeve gastrectomy (LSG). The patient experienced vomiting attacks after the operation, which led to the need for laparoscopic exploration. During reoperation, acute entrapment of the upper portion of the sleeve that had migrated through the hiatus was observed. Undoing the suture and not attempting additional hiatal repair was sufficient to alleviate the symptoms. The patient had successful weight loss without reflux and proton pump inhibitor complaints at follow-up.