A626 Hiatal hernia repair 14 years after gastric bypass with implantation of bioabsorbable mesh

Abstract

Gastric bypasses (GB) can have late complications. One of these complications is hiatal hernia with pouch migration into the mediastinum. This can cause dysphagia, reflux and even aspiration. Bariatric surgeons need to be aware of this problem, how to diagnose it, and how to treat it. This video highlights the case of a patient who underwent a laparoscopic GB in 2004. She maintained about a 45 kg weight loss but over the last 2 years had developed progressively worse symptoms of dysphagia and reflux. She was referred to our center and upper gastrointestinal series and computed tomography revealed intra-thoracic pouch migration. The video shows the images and the operative approach. Standard trocar placement for bariatric/foregut surgery is used. The pouch is dissected out of the mediastinum and adequate intra-abdominal esophageal length is obtained. The diaphragm is closed with a posterior cruroplasty and a piece of bioabsorable mesh is used as reinforcement. Post operative images are shown.