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Intraoperative gastroscopy during laparoscopic sleeve gastrectomy after gastric band surgery with unrecognized hiatal hernia—a case report

  • Miklós Siptár1,*,
  • György Tizedes2
  • Bálint Nagy3
  • Szilárd Rendeki3
  • Sándor Márton4

1Department of Anesthesiology and Intensive Therapy, Intensive Care Units, University of Pécs, Medical School, 7624 Pécs, Hungary

2DaVinci Private Clinic, 7635 Pécs, Hungary

3Department of Anesthesiology and Intensive Therapy, Intensive Care Units and University of Pécs, Medical School, Medical Skills Education and Innovation Centre, University of Pécs, Medical School, 7624 Pécs, Hungary

4Department of Anaesthesology and Intensive Therapy, Department of Obstetric Anesthesiology, University of Pécs, Medical School, 7624 Pécs, Hungary

DOI: 10.22514/sv.2023.093 Vol.19,Issue 5,September 2023 pp.254-257

Submitted: 13 October 2022 Accepted: 11 January 2023

Published: 08 September 2023

*Corresponding Author(s): Miklós Siptár E-mail:


Obesity is the civilizational disease of our era, and often leads to comorbidity, hypertension, diabetes and obstructive sleep apnea. Contemporary non-surgical treatment for obesity is frequently inefficient, resulting in the increased prominence of surgical procedures, specifically, laparoscopic sleeve gastrectomy (LSG). In our case report, we present a case in which LSG was not feasible in reference to the traditional surgical technique due to severe hiatal hernia (HH), which inexplicably went undetected during preoperative examinations, however, with the help of intraoperative gastroscopy, the problem was effectively solved. The patient, a middle-aged Caucasian male, underwent removal of a gastric band due to gastric band migration, and was presented for LSG due to repeated weight gain. During the operation, the insertion of the bougie proved unsuccessful after several attempts. Through intraoperative gastroscopy, a severe HH was discovered. The endoscope was inserted into the compromised passageway leading into the stomach, effectively substituting the role of bougie used in the traditional surgical procedure. Unexpected difficulty or inability to insert a bougie is rare in consideration of LSG, however, in this case, surgery could not have been performed in the conventional manner. During intraoperative gastroscopy, the gastroscope is inserted into the stomach using visual control, and effectively substitutes the bougie function. The likelihood of rare, yet severe, life-threatening complications from the insertion of a bougie is reduced and surgery can be performed in the traditional sense. We have no knowledge of cases in which a HH prevents the conventional surgical technique. However, in extreme cases in which the traditional non-surgical technique and other types of surgery are deemed unsuitable, intraoperative gastroscopy provides a simple and safe solution.


Bariatric surgery; Gastrectomy; Gastroesophageal reflux; Hernia; Hiatal; Gastroscopy; Comorbidity; Sleep apnea; Obstructive

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Miklós Siptár,György Tizedes,Bálint Nagy,Szilárd Rendeki,Sándor Márton. Intraoperative gastroscopy during laparoscopic sleeve gastrectomy after gastric band surgery with unrecognized hiatal hernia—a case report. Signa Vitae. 2023. 19(5);254-257.


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