Background

We present a 51-year-old male who presented with severe reflux and asthma 4 years after sleeve gastrectomy with hiatal hernia repair using biosynthetic mesh. Initial workup included upper endoscopy which showed severe sleeve stenosis at the proximal gastric body as well as grade III esophagitis. A CT scan of the abdomen showed a small hiatal hernia, thickened distal esophagus and a calcified circular fluid collection near the proximal stomach. The patient underwent robotic assisted Roux-en-Y gastric bypass with excision of mesh and hiatal hernia repair. Intraoperatively, it was evident that the sleeve stenosis was caused by a well encapsulated seroma at the site of previous mesh that was densely adherent to the proximal stomach and esophagus. Pathology demonstrated a 4.4 x 3.2 cm mass composed of fibroadipose tissue with signs of chronic inflammation and foreign body giant cells. The patient recovered well postoperatively with complete resolution of reflux symptoms. This case represents a rare cause of sleeve stenosis and well as a rare complication of biosynthetic absorbable mesh.