Background

The incidence of hiatal hernia discovered postoperative in patients who have undergone prior sleeve gastrectomy ranges from 3-45% in the literature1,2. Presence of a hiatal hernia may contribute the development or worsening of gastroesophageal reflux disease (GERD), which may lead to the development of Barrett’s esophagus, prolonged need for medical therapies, or further surgical interventions. In our practice, we have encountered multiple patients with a history of sleeve gastrectomy performed at outside institutions who later presented with worsening GERD and weight regain. Given these symptoms, they were considered for revisional surgery. During the preoperative workup of these patients, they were found to have hiatal hernias which, along with a history of sleeve gastrectomy, likely contributed to the development of GERD. While revisional surgery that combines sleeve gastrectomy conversion to Roux-en-Y gastric bypass with concomitant hiatal hernia repair can be complex and challenging, we demonstrate our operative technique for a successful approach. Adequate crural exposure and mediastinal dissection are instrumental to the hiatal hernia repair. In our patients who have undergone this revisional procedure, they have demonstrated successful weight loss and resolution of their GERD symptoms in the postoperative setting.