Robotic Heineke-Mikulicz stricturoplasty for refractory incisura angularis stenosis after sleeve gastrectomy: an anatomy-preserving case report.

Gastric sleeve stenosis is an uncommon yet serious complication following sleeve gastrectomy (SG). Initial management typically involves endoscopic balloon dilation; however, refractory cases may require revisional surgery, often conversion to a Roux-en-Y gastric bypass (RYGB). We present the case of a 44-year-old woman with a symptomatic stenosis at the incisura angularis, 1 month after SG, refractory to three endoscopic balloon dilations. Given the localized nature of the stenosis and the patient's preference to avoid bypass, she underwent robotic Heineke-Mikulicz stricturoplasty. The patient had an uncomplicated postoperative course and remained asymptomatic at follow-up. This case highlights the feasibility and advantages of stricturoplasty as an organ-preserving alternative to gastric bypass in selected patients with localized refractory sleeve stenosis, preserving gastrointestinal continuity and possibly reducing long-term nutritional considerations associated with bypass procedures. Further studies with longer follow-up are needed to better define patient selection, durability, and comparative outcomes with conversion to RYGB.