Laparoscopic removal of swallowable intragastric balloon and conversion to Roux-en-Y gastric bypass with concurrent hiatoplasty: a case report.

Swallowable intragastric balloon is a minimally invasive bariatric option for obesity, but severe intolerance requiring intervention is uncommon. We report a 41-year-old man with grade I obesity, hypertension, dyslipidemia, and hyperthyroidism who developed severe retrosternal pain, reflux, persistent vomiting, and oral intolerance 5 days after balloon placement. Computed tomography showed appropriate balloon position without migration or perforation but suggested a small hiatal hernia. Due to refractory symptoms, laparoscopic balloon removal was performed. Intraoperative findings revealed a larger hiatal hernia with paraesophageal lipoma than previously identified, prompting simultaneous hiatoplasty and conversion to Roux-en-Y gastric bypass. The patient had progressive postoperative recovery with symptom resolution and improved oral tolerance. This case highlights that severe balloon intolerance may reveal occult hiatal pathology despite inconclusive preoperative studies and demonstrates that single-stage laparoscopic balloon removal, hiatal hernia repair, and definitive bariatric surgery can be a safe, effective strategy in appropriately selected patients.