Background

Treatment of gastroesophageal reflux disease after sleeve gastrectomy can be difficult. Traditionally, when medical treatment is not efficacious, gastric bypass is performed. Some patients have had adequate weight loss or do not consent to having a bypass. When these patients have a known hiatal hernia, repair is an option, however traditional intra-abdominal fundoplication techniques are challenging or impossible because there is often not enough gastric tissue to perform a circumferential fundoplication. Thus we revisit the concept of a Belsey, a vertical fundoplication that does not require a large pouch of fundus as a Nissen or Toupet would.

Methods

A case study is presented of a 35 year old woman with a history of laparoscopic vertical sleeve gastrectomy for morbid obesity 8 years prior who has since lost 100 pounds and had a BMI of 28.46 at presentation. She returned to treatment for recurrent reflux and nocturnal vomiting. She had undergone treatment for H pylori without relief. She was requesting treatment for her reflux that did not involve a bypass.

Results

A video of a modified Belsey Mark IV hiatal hernia repair is presented. The patient tolerated the procedure well and there were no complications. Her symptoms had completely resolved at her one week follow up.

Conclusions

Transabdominal robotic Belsey Mark IV hiatal hernia repair is a viable option for patients with sleeve gastrectomy who do not wish to undergo conversion to gastric bypass.