redo in bariatric surgery for non bariatric indications; laparoscopic management of gastric volvulus with hiatal hernia two years after laparoscopic sleeve gastrectomy

introduction the popularity of sleeve gastrectomy, as a treatment for morbid obesity, has increased recently due to its safety and relatively technical simplicity. sleeve gastrectomy, however, is not free of complications and due to the increased number of cases performed with this method, new postoperative complications would be expected to be experienced. few cases of gastric volvulus are reported until the day. the reasons for volvulus are laxity of the gastric anatomical fixations, incorrect position of the stomach, rotation or improper dissection of the back of stomach. case presentations the purpose of this case study is to report a patient with morbid obesity with no remarkable medical history, who underwent laparoscopic sleeve gastrectomy with body mass index (bmi) 42 kg/m2 two years ago. his bmi was 23 kg/m2 when he referred to us. the patient showed symptoms of vomiting, abdominal pain and fullness in the postoperative period and along the two years after sleeve gastrectomy, presented with repetitive attacks of vomiting and dysphagia to solids, which suggested upper gastrointestinal occlusion and gastric volvulus of the gastric sleeve accompanied by herniated proximal sleeved stomach in the hiatus which was proved later by further investigations. follow-up investigations included barium swallow and upper gastro-intestinal tract endoscopy showed associated hiatus hernia and no obstruction, but revealed twisting of the mid-stomach with intractable reflux symptoms and obstruction was partially and temporarily corrected by endoscopy. we performed a laparoscopic dissection and made the related adhesions of the gastric sleeve and omental attachments on the back of the stomach free and then repaired the hiatal hernia with anterior fundoplication. conclusions sleeve gastrectomy leaves the stomach with no fixations along the entire greater curvature which may altogether precipitate the patients to sleeve volvulus accompanied by inadequate dissection of the back of stomach. this complication is a rare finding and reported in few cases till this date, especially when associated with hiatal hernia. so, we discuss the precipitating factors and how to avoid and manage this complication and its related morbidities.