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Hiatal hernia after sleeve gastrectomy

Case contributed by Dr Ahmed Mohamed Ali Aboughali


Mild intermittent upper abdominal pain and reflux symptoms. One year previously, she had undergone a sleeve gastrectomy for morbid obesity (BMI 48). Preoperative studies of upper gastrointestinal tract and gastroscopy were normal.

Patient Data

Age: 35 years
Gender: Female

Upper GI barium exam


Tortuous esophagus, the gastro-esophageal junction is displaced >2 cm above the esophageal hiatus and part of the gastric tube is seen displaced above the diaphragm. 


Computed Tomography


Widening of esophageal hiatus, dehiscence of diaphragmatic crura (>15 mm) and intrathoracic staple line (noted in the posterior mediastinum along the border of the herniated gastric tube).

Case Discussion

Sleeve gastrectomy (SG) is a frequent surgical procedure for the treatment of morbid obesity. De novo hiatal hernia of the gastric tube can occur as a complication.

The suggested mechanisms responsible for the development of a hiatal hernia after sleeve gastrectomy are:

  1. dissection of hiatal ligaments (phrenogastric and phreno-oesophagal ligaments during the creation of the gastric tube)
  2. tubular shape of the gastric sleeve and the difficulty in anchoring the sleeve to the surrounding structures
  3. rapid weight loss following the SG may lead to enlargement of the hiatal orifice
  4. regaining of body weight and the dilatation of the whole gastric tube might also be a factor because of the increase in intragastric pressure


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