Dr Sorin Cimpean, Digestive Surgeon

02/10/2026

Hiatal hernia (HH) with gastric (pouch) migration after gastric bypass is a rare complication, often late-term, typically years after the original surgery (reported ranges include medians around 5–12 years, with cases up to 14–16 years post-op).

Risk factors/context:
-Rapid weight loss reduces intra-abdominal fat and support.
-Altered anatomy and possible increased abdominal pressure dynamics after bypass can contribute.
-Pre-existing HH may also play a role in some cases.

Outcomes (from case series and reviews, including larger multicenter reports of ~44–45 patients):
- High short-term symptom improvement: ~70% full resolution, ~20–25% partial; overall improvement often >75–90% for obstructive symptoms.
- Low early recurrence in isolated repairs (~5% or less radiologic/symptomatic in short follow-up).

16/09/2026

Management of epiphrenic oesophageal (esophageal) diverticula is primarily guided by symptoms, as these are rare pulsion diverticula (false diverticula) almost always associated with an underlying distal esophageal motility disorder (e.g., achalasia, diffuse esophageal spasm, hypertensive LES, or nonspecific motility disorders).​

Conservative / Non-Operative Management
- Asymptomatic or mildly symptomatic patients can be managed expectantly with observation. ).​
Size alone is not an indication for intervention; symptoms correlate poorly with diverticulum size.
- Supportive measures may include dietary modifications (e.g., soft foods, flushing with liquids) if mild retention occurs.

Surgery (or endoscopic therapy) is indicated for:
-Progressive or significant symptoms: dysphagia, regurgitation, food retention, chest pain, weight loss.
-Complications: recurrent aspiration/pneumonia, perforation, bleeding, or rare malignant degeneration within the diverticulum.​

Surgical Treatment:
-Diverticulectomy (stapled resection of the diverticulum after defining the neck and mucosa).
-Longitudinal esophageal myotomy (ideally contralateral to the diverticulum; proximal extent beyond the diverticulum neck; distal extent 2–3 cm onto the gastric cardia across the EGJ/LES).
Partial fundoplication (Dor or Toupet) in most cases to reduce postoperative reflux risk, especially if the myotomy crosses the EGJ. Complete (Nissen) fundoplication is generally avoided due to the motility disorder.​

Endoscopic Options:
- Peroral endoscopic myotomy (POEM) variants (including diverticular POEM / D-POEM or septotomy ± LES myotomy) are promising, less invasive alternatives, particularly when a motility disorder is present.

In this care history of gastric sleeve.

06/09/2026

Gastric stenosis after a gastric sleeve occurs in roughly 0.1–4% of cases (some series report around 0.6–2%, with higher figures in selected symptomatic groups). Most cases present within weeks to a few months after surgery, though delayed onset (even years later) is possible.

Causes and Risk Factors
- Stenosis can be mechanical/organic (true narrowing from scarring/fibrosis) or functional (kinking, twisting/helical rotation of the staple line, or angulation without fixed stricture).

Common contributing factors include:
- Surgical technique issues (e.g., stapling too close to the lesser curvature or incisura angularis, smaller bougie size, oversewing of the staple line).
- Postoperative edema, hematoma, or healing complications.
- Scarring from staple-line leaks or ischemia.
-Axial rotation or incongruence between anterior and posterior gastric walls.

The most frequent location is the incisura angularis (mid-to-distal sleeve), followed by proximal sites.

23/08/2026

Loop gastrojejunal diversion is a surgical option used as a salvage procedure for severe, refractory gastroparesis when medical therapy, nutritional support, G-POEM, pyloroplasty, and gastric electrical stimulation have failed.

How the Procedure Works
-A latero-lateral gastro-anastomosis on the posterior side of the lower part of the stomac (antrum) is performed.
-Food bypasses the pylorus and the duodenum.
-Emptying from the small pouch depends more on gravity and jejunal motility than on gastric contractions.

Variations include leaving the remnant stomach in place or performing a near-total/subtotal gastrectomy with Roux-en-Y reconstruction.
A related but different technique is Roux-en-Y jejunostomy, used primarily for reliable long-term post-pyloric feeding rather than as a primary symptom-relieving diversion.

Indications in Severe Gastroparesis
-Debilitating, treatment-refractory symptoms (especially intractable nausea, vomiting, and pain).
-Significant malnutrition or repeated hospitalizations.
-Failure of less invasive interventions.

It is not a first- or second-line surgical treatment.

Here is a case with pre and post operative radiological study.
Significant improvement of the quality of life.

22/08/2026

Splenic hydatid cyst is a rare manifestation of cystic echinococcosis, caused mainly by the larval stage of the tapeworm Echinococcus granulosus.

The spleen is the third most common site after the liver and lungs, but involvement is uncommon (roughly 0.5–4% of abdominal hydatid cases; isolated primary splenic disease is even rarer, often

15/07/2026

Converting from gastric sleeve (sleeve gastrectomy) to Roux-en-Y gastric bypass (RYGB) is a recognized revision option for managing hiatal hernia and/or severe GERD/reflux that develops or persists after sleeve surgery.

GERD/reflux resolution: High success rates, often 70-90% improvement or resolution of symptoms, with significant reductions in PPI (acid-suppressing medication) use. Hiatal hernia repair during conversion enhances this.

Weight loss: Additional excess weight loss of ~40-60% is expected.

Here is a radiological study before and after the surgical treatment.

02/07/2026

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18/06/2026

09/06/2026

Quality of Life (QoL) after rectopexy for rectocele is generally positive for many patients, particularly regarding bowel symptoms, obstructed defecation, and overall pelvic floor function, though results vary by individual factors (e.g., prolapse severity, comorbidities, concurrent issues like intussusception or external prolapse).

Here is a case with good outcomes.
Preoperative and 1 year postoperative imagery of a laparoscopic ventral rectopexy.

07/06/2026

In case of localised descending colon diverticular disease, an segmental resection with latero-lateral colo-colic anastomosis can be a feasible option.
The main advantages are:
-Larger anastomotic diameter, potentially lower risk of stricture.
-Good for overcoming diameter discrepancies and reducing tension.