Management of a Late-Term Hiatal Hernia with Intrathoracic Pouch Migration After Roux-en-Y Gastric Bypass

Excerpt

Hiatal hernia (HH) with intrathoracic migration of the gastric pouch (IMGP) is a rare long-term complication of laparoscopic Roux-en-Y gastric bypass (LRYGB); however, its management remains poorly documented [1, 2]. Several factors may contribute to the development of this entity. Rapid weight loss can lead to the relaxation of the phreno-esophageal ligament and enlargement of the hiatus [3] allowing for easier migration. Creation of a large gastric pouch could favor its migration because of the higher intra-gastric pressure [4]. Extended dissection of the cardia and the left crus during the LRYGB may disrupt normal attachments between the cardia and diaphragm and predispose to IMGP [5]. Finally, a small sliding HH may pass unperceived pre- or even intra-operatively, or intentionally not repaired during LRYGB, leading to progression of HH after bariatric surgery [6]. …