LAPAROSCOPIC HIATAL HERNIA REPAIR IN A POST-GASTRIC BYPASS PATIENT WITH INTRATHORACIC POUCH MIGRATION AND ATYPICAL GERD lizbethgv@yahoo.com

 

LAPAROSCOPIC HIATAL HERNIA REPAIR IN A POST-GASTRIC BYPASS PATIENT WITH INTRATHORACIC POUCH MIGRATION AND ATYPICAL GERD

6

Mexico

Video

Hiatal hernia following Roux-en-Y gastric bypass (RYGB) is rare but significant, often presenting with atypical GERD and abdominal pain. This video presents the laparoscopic repair of a migrated gastric pouch in a patient with poor weight loss and refractory symptoms. The aim is to demonstrate the feasibility and clinical impact of this revisional procedure.

A 57-year-old female with prior fundoplication (2007) and RYGB (2017) presented with a 1-year history of epigastric pain, nausea, and vomiting, but no classic GERD symptoms. Preoperative evaluation showed a 5 cm hiatal hernia with pouch migration confirmed by endoscopy, barium swallow, and pH-metry. Helicobacter pylori was eradicated. Her BMI was 39.2 kg/m². Laparoscopic revision was performed using five trocars in modified lithotomy position. Intraoperative findings included intrathoracic migration of the gastric pouch, a 3 cm paraesophageal defect, dense adhesions, a 5 cm hernia sac, and an open Petersen space. The defect was repaired, adhesions released, and a Penrose drain placed. Estimated blood loss: 5 mL. Operative time: 3 hours.

The patient recovered without complications. Oral intake resumed on day 2, and she was discharged on day 3. At 3-month follow-up, she reported no GERD symptoms, required no medications, and achieved 43% excess weight loss (EWL) and 16.12% total weight loss (TWL), reducing her BMI from 39.7 to 33.

This case highlights the value of thorough preoperative evaluation and demonstrates that laparoscopic repair of post-RYGB hiatal hernia with pouch migration is safe, effective, and leads to excellent early outcomes.

https://vimeo.com/1107993769/ab395f0913?share=copy