Benjamin Clapp1, Loc-Uyen Vo2, Carlos Lodeiro2, Brittany Harper2, Simon Montelongo2, Isaac Lee2, Alan Tyroch2. 1. Department of Surgery, Texas Tech University Health Sciences Center Paul Foster School of Medicine, El Paso, Texas. Electronic address: B_clapp1@hotmail.com. 2. Department of Surgery, Texas Tech University Health Sciences Center Paul Foster School of Medicine, El Paso, Texas.
Abstract
BACKGROUND: Gastric bypasses were the most common bariatric surgery for many years, and long-term complications after gastric bypass are known to be relatively common. Symptomatic hiatal hernia (HH) with pouch migration is a less-known complication. However, when these are symptomatic, they require surgical repair. OBJECTIVE: We present a case series of late-term HH after gastric bypass and discuss the common presentation and treatment. SETTING: University program in the United States. METHODS: A retrospective chart review was performed of patients presenting with late-term HH after gastric bypass performed by a single surgeon during 2002 through 2018. The review captured presentation and symptoms, age, body mass index, time from index surgery, radiologic studies, and the reoperative details. If available, the original operative note was reviewed along with any preoperative imaging studies. A review of the literature was also performed. RESULTS: Seven patients were included in the case series. The average time from the index surgery was 11.9 years (range 9-16) and the average age of the patient at time of presentation was 60.1. The average body mass index at the time of the HH repair was 34 kg/m2. The most common presenting symptom was gastroesophageal reflux. Both computed tomography and upper gastrointestinal series were used for diagnosis with a common finding of HH and pouch migration into the mediastinum. HH repair with bioabsorbable mesh was performed in all patients, with an average operative time of 105 minutes. CONCLUSION: HH can present late after gastric bypass become symptomatic. When symptomatic, it needs to be addressed surgically and can usually be done through a minimally invasive approach.
BACKGROUND: Gastric bypasses were the most common bariatric surgery for many years, and long-term complications after gastric bypass are known to be relatively common. Symptomatic hiatal hernia (HH) with pouch migration is a less-known complication. However, when these are symptomatic, they require surgical repair. OBJECTIVE: We present a case series of late-term HH after gastric bypass and discuss the common presentation and treatment. SETTING: University program in the United States. METHODS: A retrospective chart review was performed of patients presenting with late-term HH after gastric bypass performed by a single surgeon during 2002 through 2018. The review captured presentation and symptoms, age, body mass index, time from index surgery, radiologic studies, and the reoperative details. If available, the original operative note was reviewed along with any preoperative imaging studies. A review of the literature was also performed. RESULTS: Seven patients were included in the case series. The average time from the index surgery was 11.9 years (range 9-16) and the average age of the patient at time of presentation was 60.1. The average body mass index at the time of the HH repair was 34 kg/m2. The most common presenting symptom was gastroesophageal reflux. Both computed tomography and upper gastrointestinal series were used for diagnosis with a common finding of HH and pouch migration into the mediastinum. HH repair with bioabsorbable mesh was performed in all patients, with an average operative time of 105 minutes. CONCLUSION:HH can present late after gastric bypass become symptomatic. When symptomatic, it needs to be addressed surgically and can usually be done through a minimally invasive approach.