Acute Hiatal Hernia with Incarcerated Proximal Half of Recent Sleeve Gastrectomy: Super Rare Complication
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MULTIMEDIA ARTICLE
Acute Hiatal Hernia with Incarcerated Proximal Half of Recent Sleeve Gastrectomy: Super Rare Complication Yevhen Pavelko 1
&
Roberto Bustos 1 & Stephan Gruessner 1 & Chandra Hassan 1
Received: 7 July 2020 / Revised: 29 October 2020 / Accepted: 29 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Vertical sleeve gastrectomy (VSG) has become the most commonly performed operation for the treatment of morbid obesity (JAMA. 312(9):959–61, 2014). Nevertheless, VSG is still associated with some early postoperative complications (JAMA. 312(9):959–61, 2014; Surg Obes Relat Dis. 9(5):816–29, 2013; Obes Surg. 27(8):1944–1951, 2017). Hiatal hernia is a complication that has been widely described in the literature, but not in the immediate postoperative course (Obes Surg. 17(7):962–9, 2007). We, herein, report a case of an acute postoperative hiatal hernia after sleeve gastrectomy. Methods A 29-year-old female (BMI 38.54 kg/m2) presented to our center and her options for metabolic surgery were discussed. Laparoscopic sleeve gastrectomy (LSG) was the chosen procedure. Preoperative assessment includes a chest x-ray, and standard lab-work up was within a normal limit. Barium swallow did not show any evidence of hiatal hernia. She underwent a LSG. On POD 1, she was able to pass the bariatric clears trial and was discharged home. Three days after discharge, the patient was complaining of constant nausea and vomiting, and chest pain, and was diagnosed with acute hiatal hernia with the incarceration of the proximal sleeve. The patient was taken to the operating room. Results Postoperatively, the patient started on the usual bariatric clinical pathway which she tolerated well and was discharged on the POD 4. The operative time was 156 min. The estimated blood loss was 50 ml. Conclusions Our report highlights the need for more broad differential diagnosis in early post sleeve gastrectomy patients. Those who are presented with nausea and vomiting in the early postoperative period should be evaluated for possible post sleeve hiatal hernia with a potential risk of strangulation. Keywords Bariatric surgery . Laparoscopic sleeve gastrectomy . Perioperative care . Technique . Acute hiatal hernia . Hiatal hernia . Laparoscopy . Minimally invasive surgery . Postoperative complications . Vertical sleeve gastrectomy . Fundoplasty . Incarceration . Emergency surgery
Introduction Vertical sleeve gastrectomy (VSG) has become the most commonly performed operation for the treatment of morbid obesity, surpassing gastric bypass [1]. VSG is proven to be effective in weight loss and controlling associated comorbidities in morbidly obese patients [2]. Nevertheless, it is still associated
with early postoperative complications, with bleeding and leakage as the most frequently reported [3–5]. Hiatal hernia is a complication that has been described in the literature, but it is unusual in the immediate postoperative period requiring urgent surgery [6]. Only a few cases were reported
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