OAGB as revisional surgery after laparoscopic sleeve gastrectomy in a patient with hiatal hernia and intrathoracic stomach

The number of revisional bariatric surgeries has increase substantially over the last decade, especially due to complications or inadequate results after laparoscopic sleeve gastrectomy.

We present the case of a 43-year-old patient with a history of sleeve gastrectomy performed 12 years earlier (BMI 43 kg/m²). After surgery, the patient lost weight (nadir BMI 30.1 kg/m²), but later regained weight. At the time of our assessment, he presented a BMI of 35.7 kg/m² (%TWL: 23.8%), together with de novo gastroesophageal reflux and a hiatal hernia with intrathoracic stomach (tubular).

During surgery, the diaphragm crura were dissected and closed, and the anastomosis was converted to a gastric bypass.