Gastric Fundus Obstruction From Hiatal Hernia After Sleeve Gastrectomy: A Case Report.

Sleeve gastrectomy is currently the most common bariatric procedure in the United States, with over 750,000 cases performed between 2018 and 2022. While early complications such as hemorrhage and leaks are well documented, increasing data reveal a broader range of long-term complications, including stricture, gastroesophageal reflux, and hernias. We present a rare case of gastric sleeve herniation through a hiatal hernia (HH), resulting in gastric obstruction, a phenomenon not previously documented in the literature. A 78-year-old woman presented with abdominal pain, emesis, and anorexia. Imaging revealed incarceration of the gastric sleeve within a type III HH. Robotic-assisted hernia reduction, gastric resection, and HH repair were successfully performed. Postoperative recovery was uncomplicated, although a small recurrent hernia was noted at six months. This case underscores the importance of recognizing late postoperative complications and highlights robotic-assisted repair as a safe, effective approach even in acute care settings. This report also introduces a new long-term complication of sleeve gastrectomies that clinicians should include in their differential diagnosis. Further research on the benefits of screening for and repairing HHs during index sleeve gastrectomy may help prevent this complication.