Background

INTRODUCTION As the most common bariatric surgery in the U.S., laparoscopic sleeve gastrectomy benefits and potential complications such as bleeding, infection or leak, are well-studied. We present a case of a 78-year-old female who presented with obstruction due to sleeve herniation into the mediastinum 3 years after laparoscopic sleeve gastrectomy. CASE PRESENTATION A 75 year -old woman with obesity (BMI 46), obstructive sleep apnea and osteoarthritis underwent a laparoscopic sleeve gastrectomy without complication in 2019. Intraoperatively, no hiatal hernia was visualized at that time. In 2022, the patient presented to the emergency department with obstructive symptoms, found to have migration of the gastric sleeve into the mediastinum with obstruction at the diaphragmatic hiatus (Images 1-3). She underwent robotic-assisted repair of the herniation with her original surgeon. After extensive lysis of adhesions, the fundus was reduced into the abdomen and the hiatal hernia was repaired (Images 4-6). A portion of devascularized, chronically obstructed stomach was resected to avoid postoperative perforation or necrosis. Patient was discharged on postoperative day 4 on a clear liquid bariatric diet. She has followed up in the outpatient office without issue. DISCUSSION Bariatric centers have increasingly standardized protocols to ensure patient safety. To our knowledge, this case, which describes migration of a laparoscopic gastric sleeve leading to obstruction and herniation of the gastric fundus 3 years after the index operation, is unique and warrants further study as a possible complication of sleeve gastrectomies. This may impact long-term surveillance of patients under bariatric surgeons’ care.