Intragastric Nonabsorbable Sutures From Prior Endoscopic Sleeve Gastroplasty Discovered During Robotic Hiatal Hernia Repair: A Case Report

Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive bariatric procedure that utilizes endoscopic suturing to reduce gastric volume. While generally considered safe, delayed complications related to retained suture material are incompletely characterized in the literature. We report a case of intragastric nonabsorbable sutures discovered during revisional hiatal hernia surgery in a patient with a remote history of prior foregut intervention. A 58-year-old woman with a history of hiatal hernia repair with fundoplication approximately 10 years prior presented for surgical evaluation of recurrent gastrointestinal symptoms, including postprandial abdominal discomfort, bloating, and prior episodes of melena. Upper endoscopy demonstrated abnormal gastric anatomy, gastritis, and a nodular lesion associated with exposed suture material within the gastric body. Imaging and endoscopic findings raised concern for recurrent hiatal hernia with possible failed fundoplication. The patient subsequently underwent laparoscopic robotic hiatal hernia repair with intraoperative endoscopy. During intraoperative endoscopic evaluation, multiple intraluminal nonabsorbable sutures were identified extending from the gastric antrum to the fundus. These sutures were protruding into the gastric lumen and appeared consistent with retained material from a prior endoscopic gastric plication procedure, most likely ESG. The sutures were excised and removed prior to completion of the hiatal hernia repair. Pathologic examination confirmed intragastric foreign bodies composed of suture material. The patient tolerated the procedure well and was discharged on postoperative day one without complications. This case highlights a rare delayed presentation of intragastric suture foreign bodies likely originating from prior endoscopic gastric plication. Awareness of this potential long-term complication is important for surgeons and gastroenterologists managing patients with prior endoscopic bariatric interventions.