Seromyotomy as an alternative to gastric bypass for post-sleeve gastrectomy stricture: a case report

Laparoscopic sleeve gastrectomy (LSG) is widely performed, but postoperative strictures, most commonly at the incisura angularis, remain a challenging complication. These are often functional, resulting from angulation of the gastric tube. While endoscopic balloon dilation is the first-line therapy, some patients require surgical intervention. Conversion to Roux-en-Y gastric bypass (RYGB) is traditionally the default treatment. Laparoscopic seromyotomy offers an anatomy-preserving alternative in select cases. We report a 35-year-old female with prior LSG and paraesophageal hernia repair who developed progressive food intolerance due to a functional incisura stricture. Endoscopy demonstrated sharp luminal angulation without fixed narrowing. Given the patient's preference to avoid RYGB, a diagnostic laparoscopy with seromyotomy was performed. Postoperative imaging confirmed resolution of the stricture without leak. The patient tolerated a solid diet and remained asymptomatic without reflux at 2-year follow-up. Laparoscopic seromyotomy is a viable option for carefully selected patients with refractory functional strictures following LSG.