Transhiatal sleeve gastrectomy migration and GERD: laparoscopic hiatal hernia repair with reinforcement and conversion to R-en-Y gastric bypass

Background: Transhiatal sleeve migration, with consecutive gastroesophageal reflux disease (GERD) is a complication that leads to revisional surgery. Methods: A fifty-five years old, morbid obese female patient with BMI 45 kg/m2, hypertensive with OSAS and hypercholesterolemia, was operated by laparoscopic sleeve gastrectomy in 2010. She reached nadir in 2012 with BMI 28.7, with resolution of her comorbidities. From 2016 she complained from symptomatic GERD not responding to medical treatment, with evidence of transhiatal sleeve migration on radiological contrast study (Gastrografin), and on the CT scan of the hiatal area. Results: we present the video of conversion to laparoscopic R-en-Y gastric bypass LRYGB, associated with reinforced cruroplasty with bioabsorbable mesh, with marked improvement of GERD symptoms after reoperation. Conclusion: laparoscopic conversion from LSG to RYGB is feasible and useful for LSG complications.