Dr Sorin Cimpean, Digestive Surgeon

22/02/2026

Here is hiatal recurrence few years after the placement of a slowly resorbable mesh. In this case this late recurrences (>12 months post-op) occurred in left-lateral hiatus, in the least reinforced area in traditional posterior-focused repairs where the mesh was not previously placed.
If native tissue healing is incomplete or compromised, recurrence can develop after mesh resorption.
In case of U-shaped posterior mesh configuration leaves the anterior and left-lateral hiatus vulnerable to stretching.
This is attributed to progressive stretching from ongoing physiological stresses rather than acute technical failure.
If native tissue ingrowth is suboptimal (e.g., due to tension or poor healing), recurrence can emerge as support diminishes—though studies show no direct link to resorption timing causing failure; instead, it's more about overall repair durability.

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21/02/2026

-GERD/reflux remains the leading reason for revisional surgery after Sleeve.
-Sleeve Gastrectomy can worsen or cause new-onset severe reflux due to increased intragastric pressure and loss of the angle of His.
- Also weight regain or inadequate weight loss, where the restrictive effect alone isn't sufficient long-term can be indications for conversion

-Conversion to RYGB is often preferred over alternatives (e.g., re-sleeve, duodenal switch, or one-anastomosis bypass) for GERD due to superior reflux control.
-Hiatal closure, if hiatal hernia present, is mandatory

-This Re-do surgery is marked by multiple technical challenges:
The surgical field presents distorted landmarks
The normal gastroesophageal junction anatomy is often displaced
The gastric sleeve creates a more rigid, tubular structure rather than a pliable stomach
Previous staple lines create fibrotic tissue planes

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13/02/2026

13/02/2026

Sliding hiatal hernias occur when the gastroesophageal junction (GEJ) and the upper part of the stomach slide upward through the diaphragmatic hiatus. It is often directly linked to reflux.

For surgical candidates, comprehensive workup (endoscopy + radiological study + manometry + pH measurement ) is recommended to assess motility, reflux severity, and hernia type/size.

The solution : cruroplasty (suturing the crura) + fundoplication (e.g., Nissen or Toupet) to address GERD with use of mesh for specific cases.

06/02/2026

Silastic Ring Vertical Gastroplasty (SRVG) 18 years ago and silastic removal 2 years ago.

Studies report stenosis it in around 8-9% of patients in long-term follow-up (e.g., 8.92% in one 10-year study).

Actually important dysphagia.
Indication for conversion to RYGB.

21/01/2026

In patients who have undergone gastric sleeve surgery, a potential complication is intrathoracic migration (also called sleeve migration or pouch migration) of the remaining gastric sleeve into the hiatal hernia defect.

This can happen due to factors like incomplete hiatal hernia repair during the original surgery, changes in anatomy after weight loss, or increased intra-gastric pressure.

An abdominal reduction of the stomac, hiatal closure and conversion to Roux-en-Y gastric bypass is the first option.

11/01/2026

Hiatal closure with non-absorbable barbed V-Loc (running suture) to approximate the crura under reduced tension is described as safe, efficient, and effective in several series, with advantages including:
- Better tissue apposition and even tension distribution: potentially better tissue approximation and less tearing through fragile crural muscle.
- Permanent strength → may help resist long-term recurrence from diaphragm motion and intra-abdominal pressure.
- Knotless design avoids bulky knots that could cause irritation or dysphagia, but also adhesions.

Here is a video of a Nissen surgery that I performed using non-absorbable V Loc:

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10/01/2026

Retrore**al hamartoma, also known as retrore**al cystic hamartoma or tailgut cyst, is a rare congenital cystic lesion that develops in the presacral (retrore**al) space — the potential space located behind the re**um and in front of the sacrum and coccyx.
It arises from embryonic remnants of the postanal primitive hindgut (tailgut) that fail to regress completely during fetal development.

-Extremely rare — only a few hundred cases reported in medical literature.
-Strong female predominance (typically 3:1 to 5:1 ratio), most commonly diagnosed in middle-aged women (30–60 years), though it can occur at any age, including rarely in children or men.
-Usually benign, but carries a small but important risk of malignant transformation.

Symptoms:
-Chronic constipation or change in stool caliber
-Re**al fullness or pressure
-Lower abdominal, pelvic, or perineal pain
-Lower back pain
-Urinary symptoms (e.g., frequency)
-Rarely: re**al bleeding, infection (mimicking abscess or fistula), or neurological issues

Complete surgical excision is the standard of care — even in asymptomatic cases — to prevent complications like infection, recurrence, fistulization, or malignant degeneration.
Approaches depend on size/location:
Transsacral, transanal/transre**al, abdominal (open/laparoscopic), or combined.

24/12/2025

20/12/2025

19/12/2025

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10/12/2025

Intrathoracic Hiatal Hernia

An intrathoracic hiatal hernia occurs when a significant portion of the stomach protrudes through the diaphragm into the chest cavity, often representing an advanced stage of a hiatal hernia. While smaller hiatal hernias may be asymptomatic, intrathoracic variants can lead to serious complications due to the mechanical distortion of the stomach and pressure on surrounding structures like the esophagus, lungs, and heart

Complications:

1. Gastroesophageal Reflux Disease (GERD) and Esophagitis
Large hernias allow stomach acid and contents to reflux into the esophagus, causing heartburn, regurgitation, acid reflux, difficulty swallowing (dysphagia), chest or abdominal pain, early satiety, and shortness of breath.

2. Mechanical Obstruction and Vascular Compromise
-Incarceration and Strangulation: This is a surgical emergency with a risk of about 5% in paraesophageal types.
-Gastric Volvulus: Twisting of the stomach (often >180 degrees) can cause acute obstruction, severe pain, and vomiting.
-Tension Gastrothorax: Extreme herniation compresses the lungs and heart, mimicking tension pneumothorax and causing hemodynamic instability.

3. Bleeding and Anemia
Chronic or acute bleeding from erosions (e.g., Cameron ulcers in the herniated stomach), esophagitis, or ulcers can lead to iron-deficiency anemia. This is often insidious but can present with fatigue, pallor, or melena.

4. Perforation
Rare but life-threatening rupture of the herniated stomach, often due to ulceration or increased pressure, leading to peritonitis or mediastinitis.

5. Respiratory Complications
-Compression of lung tissue by the herniated organs can cause dyspnea (shortness of breath), exertional dyspnea, atelectasis (lung collapse), and reduced lung function.
-Aspiration of gastric contents into the lungs may trigger pneumonia, asthma exacerbations, or chronic cough.

Many complications are preventable with early surgical repair for symptomatic or large hernias.