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Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: a case report.

Siow SL, Tee SC, Wong CM - J Med Case Rep (2015)

Bottom Line: A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen.A Toupet fundoplication was performed to recreate the antireflux valve.She had an uneventful recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia. szeli18@yahoo.com.

ABSTRACT

Introduction: Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia.

Case presentation: A 55-year-old Chinese woman presented to us with symptoms suggestive of gastric outlet obstruction for one year. A chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity, where a diaphragmatic hernia was initially suspected. A computed tomography scan and barium swallow study demonstrated the presence of a type III paraesophageal hernia with intrathoracic upside-down stomach. A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen. The mediastinal part of the hernial sac was excised. Adequate intraabdominal length of oesophagus was achieved after resection of the sac and circumferential oesophageal dissection. A lateral releasing incision was made adjacent to the right crus to facilitate crural closure. The diaphragmatic defect and the hiatal closure were covered with a composite mesh. A Toupet fundoplication was performed to recreate the antireflux valve. She had an uneventful recovery. She had no relapse of previous symptoms at her six-month follow-up assessment.

Conclusions: Laparoscopic repair of such a condition can be accomplished successfully and safely when it is performed with meticulous attention to the details of the surgical technique.

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Related in: MedlinePlus

Port position. 1: Supraumbilical 12-mm camera port; 2: Left mid-clavicular 11-mm right-hand working port; 3: Right mid-clavicular 5-mm left-hand working port; 4: Subxiphoid 5-mm liver retraction port and 5: Left anterior axillary 5-mm retraction port. (Black denotes 11 to 12 mm ports and red denotes 5mm ports).
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Fig2: Port position. 1: Supraumbilical 12-mm camera port; 2: Left mid-clavicular 11-mm right-hand working port; 3: Right mid-clavicular 5-mm left-hand working port; 4: Subxiphoid 5-mm liver retraction port and 5: Left anterior axillary 5-mm retraction port. (Black denotes 11 to 12 mm ports and red denotes 5mm ports).

Mentions: The surgery was performed with her in a modified lithotomy position, under general anaesthesia. The surgeon stood between her legs (the French position), with the camera surgeon at her right side and the assistant at her left side. Five trocars were used (Figure 2): one supraumbilical 12mm camera port, one 11mm left midclavicular right-hand working port, one 5mm right midclavicular left-hand working port, one 5mm left anterior axillary retraction port and one 5mm subxiphoid Nathanson liver retractor port (Cook Medical, Bloomington, USA). The initial entry into the abdomen was obtained with a bladeless 12mm trocar (XCEL®, Ethicon Endo-surgery, Cincinnati, USA) under direct telescopic visualization using a 10mm 0° laparoscope (Karl Storz Endoscopy, Tuttlingen, Germany). Once all the trocars were inserted, she was tilted into the reverse Trendelenburg position (20 to 30°).Figure 2


Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: a case report.

Siow SL, Tee SC, Wong CM - J Med Case Rep (2015)

Port position. 1: Supraumbilical 12-mm camera port; 2: Left mid-clavicular 11-mm right-hand working port; 3: Right mid-clavicular 5-mm left-hand working port; 4: Subxiphoid 5-mm liver retraction port and 5: Left anterior axillary 5-mm retraction port. (Black denotes 11 to 12 mm ports and red denotes 5mm ports).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4355978&req=5

Fig2: Port position. 1: Supraumbilical 12-mm camera port; 2: Left mid-clavicular 11-mm right-hand working port; 3: Right mid-clavicular 5-mm left-hand working port; 4: Subxiphoid 5-mm liver retraction port and 5: Left anterior axillary 5-mm retraction port. (Black denotes 11 to 12 mm ports and red denotes 5mm ports).
Mentions: The surgery was performed with her in a modified lithotomy position, under general anaesthesia. The surgeon stood between her legs (the French position), with the camera surgeon at her right side and the assistant at her left side. Five trocars were used (Figure 2): one supraumbilical 12mm camera port, one 11mm left midclavicular right-hand working port, one 5mm right midclavicular left-hand working port, one 5mm left anterior axillary retraction port and one 5mm subxiphoid Nathanson liver retractor port (Cook Medical, Bloomington, USA). The initial entry into the abdomen was obtained with a bladeless 12mm trocar (XCEL®, Ethicon Endo-surgery, Cincinnati, USA) under direct telescopic visualization using a 10mm 0° laparoscope (Karl Storz Endoscopy, Tuttlingen, Germany). Once all the trocars were inserted, she was tilted into the reverse Trendelenburg position (20 to 30°).Figure 2

Bottom Line: A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen.A Toupet fundoplication was performed to recreate the antireflux valve.She had an uneventful recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia. szeli18@yahoo.com.

ABSTRACT

Introduction: Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia.

Case presentation: A 55-year-old Chinese woman presented to us with symptoms suggestive of gastric outlet obstruction for one year. A chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity, where a diaphragmatic hernia was initially suspected. A computed tomography scan and barium swallow study demonstrated the presence of a type III paraesophageal hernia with intrathoracic upside-down stomach. A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen. The mediastinal part of the hernial sac was excised. Adequate intraabdominal length of oesophagus was achieved after resection of the sac and circumferential oesophageal dissection. A lateral releasing incision was made adjacent to the right crus to facilitate crural closure. The diaphragmatic defect and the hiatal closure were covered with a composite mesh. A Toupet fundoplication was performed to recreate the antireflux valve. She had an uneventful recovery. She had no relapse of previous symptoms at her six-month follow-up assessment.

Conclusions: Laparoscopic repair of such a condition can be accomplished successfully and safely when it is performed with meticulous attention to the details of the surgical technique.

Show MeSH
Related in: MedlinePlus