Laparoscopic mesh repair of giant hiatal hernia.
Perzabal-Avilez CT, Lopez-Jaime CA, Jimenez-Soto RA, Michaus-Salais V, Dominguez-Gonzalez BB. Laparoscopic mesh repair of giant hiatal hernia. Case report. Am J Med Surg. 2020; 2(4). 1-5.
From the Division of General surgery and Laparoscopy at Hospital General de Ciudad Juarez, Chihuahua, Mexico. Received on December 1, 2020. Accepted on December 9, 2020. Published on December 15, 2020.
Abstract: In 1853, Bowditch published the description of a hiatal hernia for the first time. A giant hiatal hernia is defined as the protrusion of the abdominal contents through the diaphragmatic hiatus that is ≥30% of the stomach or ≥ 5 cm, usually type III or IV that is accompanied by a hernia sac.
A 77-year-old female presented to the emergency room with chest pain of an oppressive type, accompanied by mild dyspnea. The laboratories showed a mild anemia. A chest X-ray with evidence of an air-fluid level in the basal region of the left hemithorax, for which the study was complemented with a thoracoabdominal computed tomography, which confirms a suspected diagnosis, grade IV hiatal hernia.
She is taken to the operating room, where under general anesthesia, the hernia content reduction is performed (stomach, omentum and small intestine), an expanded polytetrafluoroethylene mesh is introduced, which is fixed with suture and a 360 ° Nissen fundoplication is performed.
Symptoms can be classified as obstructive and non-obstructive. Epigastric pain, postprandial fullness, early satiety, nausea, regurgitation, emesis, and swelling correspond to an obstructive cause, while gastroesophageal reflux, erosive esophagitis, and anemia due to ulcerations correspond to non-obstructive ones.
The points to be taken into consideration are hernia repair consisting of complete reduction of the same, evaluation of esophageal length and appropriate use of lengthening, and management of gastroesophageal reflux disease with an antireflux procedure.
Keywords: Hiatal hernia, gastroesophageal reflux, laparoscopy, fundoplication, mesh.