Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 5 2026 05 04 224 228 EN Vittoria Giordano Ceccarini Hospital of Riccione, University of Ferrara, AUSL Romagna, Italy. Michele Grassia Ceccarini Hospital of Riccione, University of Ferrara, AUSL Romagna, Italy. Giulia Vitali Ceccarini Hospital of Riccione, University of Ferrara, AUSL Romagna, Italy. Angelo Ciarrocchi Ceccarini Hospital of Riccione, University of Ferrara, AUSL Romagna, Italy. Paolo Carcoforo Ceccarini Hospital of Riccione, University of Ferrara, AUSL Romagna, Italy. Andrea Lucchi Ceccarini Hospital of Riccione, University of Ferrara, AUSL Romagna, Italy. 2025 12 05 2025 12 16 Hour-glass stomach, a rare anatomical variant characterized by a narrowed gastric segment, presents with significant clinical challenges, including postprandial pain, nausea, vomiting, and malnutrition. This report details two cases of hour-glass stomach and their surgical management. The first case involved a 58-year-old female presenting with persistent esophageal reflux and dyspepsia, initially treated with laparoscopic sleeve gastrectomy, subsequently revised to a Roux-en-Y gastrojejunostomy due to delayed gastric emptying. The second case was a 28-year-old male who presented with a hiatal hernia, abdominal pain, and vomiting, and who underwent a combined laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in a single procedure. Both patients were diagnosed using radiographic imaging with water-soluble contrast. The surgical approach, combining sleeve gastrectomy to address the anatomical narrowing and Roux-en-Y bypass to improve gastric emptying, resulted in symptom resolution and no recurrence at 2-month follow-up. This case series highlights the efficacy of this surgical strategy in managing hour-glass stomach and emphasizes the importance of radiographic imaging for diagnosis and postoperative assessment. Further studies with larger patient cohorts are needed to establish standardized treatment protocols and long-term outcomes. https://crcp.tums.ac.ir/index.php/crcp/article/view/1141 https://crcp.tums.ac.ir/index.php/crcp/article/download/1141/751