Background

Current literature reports the incidence of hiatal hernia in morbidly obese patients is as high as 40%. Hiatal Hernia (HH) is well documented as a high-risk factor for gastro-esophageal reflux disease (GERD). It has been recommended that patients having bariatric surgery with observed hiatal hernia have a repair at time of procedure. However, evidence suggest that performing surgical repair of hiatal hernia including closure of the crura and fundoplication in patients with BMI > 35 is routinely avoided due to a high failure rate. We herein represent the case of a 32-year-old morbidly obese woman, BMI 40 and hiatal hernia who underwent a sleeve gastrectomy and hiatal hernia repair. On postoperative day one the patient had persistent nausea and retching and inability to tolerate oral liquids. An upper GI series was performed which was consistent with obstruction at the hiatus and evidence of recurrent hiatal hernia with kinking of the stomach above the hiatus. The patient underwent emergent Laparoscopic repair of recurrent hiatal hernia and gastropexy and was discharged two days later without any further episodes of PO intolerance. She remained asymptomatic at three- and six-month intervals except for some postprandial left shoulder pain. This case highlights a high-risk recurrence of HH after sleeve gastrectomy with concomitant hiatal hernia repair, requiring emergent return to the operating room for repair.