Laparoscopic hiatal hernia augmentation following sleeve gastrectomy using a “mesh sling” tethered to ligamentum teres – Case report of a novel technique

Symptomatic hiatal hernia following sleeve gastrectomy is a well known and documented complication. The gold standard for its treatment is to perform a hiatal hernia repair combined with conversion of the sleeve to a gastric bypass. However, in some patients a gastric bypass may not be indicated or the patient may be unwilling for the conversion. In these situations, the ligamentum teres augmentation combined with hiatal hernia crural repair seems to be the most effective and popular, according to a literature survey. To avoid damaging the sleeve, the use of prosthetic materials to augment the hiatal repair is generally not recommended. In this case report, for a patient who presented with a hiatal hernia with severe reflux following a sleeve gastrectomy, we describe a novel technique where a sling composed of a strip of composite mesh was loosely placed around the gastroesophageal junction and tethered to a shortened ligamentum teres.