Ayman M. Soliman, Hesham Maged, Ahmed M. Awad, Osama El-Shiekh,
Volume 1, Issue 2 (11-2012)
Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) has become popular both as a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease (GERD) is a common co-morbid disease in bariatric patients. Objectives: The aim of this study was to evaluate the efficacy of LSG and hiatal hernia repair (HHR) to treat obesity, complicated by hiatus hernia (HH). Patients and Methods: The participants in the study were twenty patients, 14 women and 6 men, with a mean body mass index of 43.4 ± 1.9 kg/m2 and mean age of 47 years. All the subjects were eligible for LSG and eight were found to have esophagitis at preoperative endoscopy. Patients with Barrett’s esophagus were excluded. GERD symptom questionnaire, 24-hour esophageal pH-metry, and manometry were employed as Preand post-procedure assessments. The mean follow-up period was eight months. Clinical outcomes were also evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence. Results: Symptomatic HH was diagnosed preoperatively in 18 patients. In the other two patients, HH was asymptomatic and was diagnosed intra-operatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with an HH > 5 cm. Mortality was nil and no complications occurred. After a mean follow-up of seven months, GERD symptoms resolution occurred in nine patients, while the other patients reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m2 . Conclusions: A laparoscopic hiatal repair with or without commercially available onlay reinforcement biologic mesh and a sleeve gastrectomy performed at the same time, was successful in controlling the reflux symptoms and reducing body weight.
Ayman Mohamad Shaker Soliman, Mohamad Abdel Rahman, Fady Makram,
Volume 3, Issue 3 (8-2014)
Abstract
Introduction
The popularity of Sleeve Gastrectomy, as a treatment for morbid obesity, has increased recently due to its safety and relatively technical simplicity. Sleeve gastrectomy, however, is not free of complications and due to the increased number of cases performed with this method, new postoperative complications would be expected to be experienced. Few cases of gastric volvulus are reported until the day. The reasons for volvulus are laxity of the gastric anatomical fixations, incorrect position of the stomach, rotation or improper dissection of the back of stomach.
Case Presentations
The purpose of this case study is to report a patient with morbid obesity with no remarkable medical history, who underwent laparoscopic sleeve gastrectomy with body mass index (BMI) 42 kg/m2 two years ago. His BMI was 23 kg/m2 when he referred to us. The patient showed symptoms of vomiting, abdominal pain and fullness in the postoperative period and along the two years after sleeve gastrectomy, presented with repetitive attacks of vomiting and dysphagia to solids, which suggested upper gastrointestinal occlusion and gastric volvulus of the gastric sleeve accompanied by herniated proximal sleeved stomach in the hiatus which was proved later by further investigations. Follow-up investigations included barium swallow and upper gastro-intestinal tract endoscopy showed associated hiatus hernia and no obstruction, but revealed twisting of the mid-stomach with intractable reflux symptoms and obstruction was partially and temporarily corrected by endoscopy. We performed a laparoscopic dissection and made the related adhesions of the gastric sleeve and omental attachments on the back of the stomach free and then repaired the hiatal hernia with anterior fundoplication.
Conclusions
Sleeve gastrectomy leaves the stomach with no fixations along the entire greater curvature which may altogether precipitate the patients to sleeve volvulus accompanied by inadequate dissection of the back of stomach. This complication is a rare finding and reported in few cases till this date, especially when associated with hiatal hernia. So, we discuss the precipitating factors and how to avoid and manage this complication and its related morbidities.
