[Mediastinal herniation of the gastric remnant: an unusual complication following laparoscopic sleeve gastrectomy].

Abstract

Given that metabolic-bariatric surgery outperforms traditional treatments in both efficacy and cost-efficiency, its prevalence is expected to grow in the future. Accordingly, proficiency in identifying and managing associated complications becomes a critical competency in everyday clinical practice. Laparoscopic sleeve gastrectomy remains the most prevalent bariatric procedure due to its standardized surgical technique, excellent clinical outcomes, and favorable safety profile. The report details a case in which a patient, who had previously been symptom-free for four years after sleeve gastrectomy, developed newly onset severe gastro-esophageal reflux disease and dysphagia. Diagnostic evaluation via barium swallow and endoscopy revealed a saccular eventration of the proximal gastric remnant, which had herniated through the diaphragm into the mediastinum, resulting in extrinsic compression of the distal esophagus. A laparoscopic surgical revision was performed, involving resection of the enlarged gastric fundus and repair of the hiatal hernia. Given the severity of the patient's reflux symptoms, the procedure was converted from sleeve gastrectomy to a Roux-en-Y gastric bypass. The postoperative course was uneventful, and the patient was subsequently discharged. After the revisional surgery, the patient's symptoms subsided, and her weight remained consistent. As dysphagia following laparoscopic sleeve gastrectomy may arise from diverse etiologies, precise differential diagnosis is essential for determining the definitive treatment modality. Orv Hetil. 2026; 167(37): 1488-1492.