Amor Imed Ben, Debs Tarek, Kassir Radwan, Anty Rodolphe, Amor Virginie Ben, Gugenheim Jean
Department of General Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
Department of Bariatric Surgery, CHU Nord Hospital, Jean Monnet University, Saint Etienne, France.
Int J Surg Case Rep. 2015;15:78-80. doi: 10.1016/j.ijscr.2015.08.029. Epub 2015 Aug 20.
Sleeve gastrectomy (SG) is a frequently used surgical procedure for the treatment of morbid obesity. Several complications of SG have been described; however, de novo hiatal hernia of the gastric tube, as a complication of SG, has not been described in the literature.
Here, we report a case of a hiatal hernia 2 years after SG. In the case reported here, the hiatal hernia was associated with weight regain. The mechanisms responsible for the herniation of the pouch are difficult to identify. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass is an effective treatment for this complication. Its management is safe and effective.
Obesity itself is an independent risk factor for hiatal hernia, found preoperatively in more than half of the morbidly obese patients. This predisposition is explained by higher intra-gastric pressure due to intra-abdominal or visceral fat, reduced inferior oesophageal sphincter pressure, and oesophageal motility problems.
To our knowledge, this is the first described case of hiatal hernia of the gastric tube after SG.
袖状胃切除术（SG）是治疗病态肥胖症常用的外科手术。SG的几种并发症已有描述；然而，作为SG的一种并发症，胃管新发食管裂孔疝在文献中尚未见报道。
在此，我们报告1例SG术后2年发生食管裂孔疝的病例。在本病例中，食管裂孔疝与体重反弹相关。导致胃囊疝出的机制难以确定。将袖状胃切除术转换为Roux-en-Y胃旁路术是治疗该并发症的有效方法。其治疗安全有效。
肥胖本身就是食管裂孔疝的独立危险因素，术前在半数以上的病态肥胖患者中可发现。这种易患倾向可通过腹内或内脏脂肪导致的胃内压力升高、食管下括约肌压力降低以及食管动力问题来解释。
据我们所知，这是首例关于SG术后胃管食管裂孔疝的病例报道。
