Emergency Sleeve Gastrectomy as Rescue Treatment for Acute Gastric Necrosis Due to Type II Paraesophageal Hernia in an Obese Woman with Gastric Banding

Abstract

A morbidly obese 42-year-old woman presented with a 1-week history of left chest pain. She had undergone laparoscopic adjustable gastric banding 16 months earlier with a body mass index (BMI) of 49.2 kg/m2. Diagnostic workup revealed a large left pleural empyema and ruled out band slippage. At left thoracotomy, a misdiagnosed type II paraesophageal strangulated hernia with gastric necrosis and large perforation of the fundus was evident. At laparotomy, the band was removed, the stomach was reduced into the abdomen, and a sleeve gastrectomy was performed. Her postoperative course was uneventful, and 6 months after surgery, her BMI is 31 kg/m2. Emergency sleeve gastrectomy could represent a good option to treat, at the same time and in a safe way, both gastric necrosis and paraesophageal hernia, improving the good results in terms of weight loss after gastric restriction from gastric banding.

Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery

“…There were, of course, many findings (such as gastritis) that are of no relevance to the choice of bariatric procedure. On the other hand, there were findings, such as hiatal or paraesophageal hernia, which may be exacerbated after AGB [11][12][13][14]: peptic ulcers may be problematic in SG if the resection line runs through the ulcer or in RYGBP if the ulcer is located in the gastric remnant and ulcer bleeding occurs during the postoperative course [30]; submucous tumors or polyps should be extendedly diagnosed by endoscopic ultrasound and (endoscopically) resected before any bariatric procedure when indicated, because morbid obesity is an independent risk factor for the development of upper gastrointestinal malignancies and because there are reports of incidental intraoperative findings of gastric tumors during bariatric surgery [31].…”

“…However, there is evidence that the chosen procedure might be changed, if specific pathological upper GI findings are known preoperatively. For example, gastric banding should be avoided in cases of known hiatal or paraesophageal hernia [11][12][13][14] or gastric bypass is recommended in cases of Barrett's esophagus caused by GERD [14,15]. Because morbidly obese patients per se are at high perioperative risk, the chosen procedure should be as safe as possible.…”

The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007

“…It was noted that patients occasionally lost significant weight so that they did not require the second stage. Also, the SG was performed in some patients whose weight was not severe enough to warrant the usual bariatric operations [9][10][11][12][13][14][15][16]. Eventually, some surgeons performed the SG as their sole bariatric operation, going on to a second stage only where the weight loss was inadequate [17].…”

Initial Experience with Laparoscopic Crural Closure in the Management of Hiatal Hernia in Obese Patients Undergoing Sleeve Gastrectomy

“…Laparoscopic sleeve gastrectomy (LSG) with HHR has been recently proposed for the management of a symptomatic HH in morbid obese patients [31,32]. The aim of this paper is to report our experience of six patients submitted to this procedure in our department…”