Pt. is a 41 year old female refered to me for evaluation for cholecystectomy,secondary to postprandial bloating in the epigastrium and cholelithiasis on US.
All sounds straight forward until on questioning she reveals that that she has had a verticaly banded gastroplasty 6 years ago.Now her symptoms seem not so staight forward.
UGI shows a large caliber stricture and follw up EGD shows benign stricture at 33cm,surgicaly created stricture at aprox 40cm aand on retroflexionthe fundus lateral to this migrating back and forth with respiration in and out of the chest. When I went back and reviewed the UGI staple line was seen in the chest. At the EGD I dilated her EG junction stricture, started her on Prilosec and am waiting for her to come back to assess her symptoms.
The question to pose is, is the fundus lateral to the staple line a paraesophogeal hernia bearing the same risk as other paraesopphageal hernias and should it be repaired? If so what repair? She has no reflux since her bariatric surgery.
Or would just removing her gallbladder and reapraising her symptoms be most appropriate.