Large Para Esophageal Hernia in Elderly Patients: Laparoscopic Posterior Cruroplasty and Anterior Gastropexy

Wissam G El Hajj Moussa, Simon E Rizk, Elias SMakhoul and Elie H Chelala

Department of General Surgery, Holy Spirit University of Kaslik, Lebanon
Department of Gastro-Enterology, Holy Spirit University of Kaslik, Lebanon

^*Correspondance to: Elie H Chelala 

 PDF  Full Text DOI: 10.25107/2474-1647.2491

Abstract

Background: Para Esophageal Hernia (PEH) is a rare form of hiatal hernia, which commonly occurs in elderly people. Although asymptomatic, it can be associated with severe life-threatening complications, such as gastric volvulus. Surgical treatment is reserved for symptomatic patients. Anterior gastropexy can be an alternative treatment for elderly patients with comorbidities. Herein, we present two cases of complicated PEH that were treated with laparoscopic posterior cruroplasty and anterior gastropexy. Case Summary: An 88-year old woman with a history of Gastro-Esophageal Reflux Disease (GERD), presented with epigastric pain, hematemesis and food intolerance for the last two days. Physical exam revealed mild abdominal distention. Chest X-ray showed a left thoracic opacity, and barium swallow images showed a mixed type III PEH. Abdominal CT-scan images confirmed the diagnosis of incomplete gastric volvulus complicating the PEH. The patient underwent a laparoscopic hernia reduction with sac excision, posterior cruroplasty and anterior gastropexy with continuous barbed suturing. The postoperative course was uneventful, and follow-up at 1 and 3 months showed complete resolution of her symptoms. A 91-year old patient was admitted with dyspnea and fever associated with vomiting and food intolerance for the last 7 days. Physical exam revealed absent sounds on both lungs. Chest X-ray showed bilateral pleural effusions with a large left opacity suggestive of a hiatal hernia. CT-scan images revealed a giant PEH with complete gastric volvulus. The patient underwent emergency laparoscopic hernia reduction and sac excision, with reinforced posterior cruroplasty, and anterior gastropexy with continuous barbed suturing. There were no surgical complications, but the patient died on the 4th day postoperatively due to respiratory failure. Conclusion: Early laparoscopic posterior cruroplasty and anterior gastropexy is a safe and effective surgical alternative for elderly patients with comorbidities, presenting with symptomatic PEH.

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Cite the article

El Hajj Moussa WG, Rizk SE, SMakhoul E, Chelala EH. Large Para Esophageal Hernia in Elderly Patients: Laparoscopic Posterior Cruroplasty and Anterior Gastropexy. Clin Surg. 2019; 4: 2491.