Abstract Video Descrption Background To demonstrate the emergency laparoscopic reduction and repair of an acute recurrent Type-III hiatal hernia in a regional hospital. Case presentation A mid 70-year-old female presented with acute severe retrosternal chest pain, epigastric pain, and vomiting. She has a past surgical history of laparoscopic fundoplication 6 years earlier. Cardiac troponin was normal. CT angiogram excluded thoracic aneurysm, aortic dissection, and pulmonary embolism. Oesophagus was dilated with air-fluid level with a large hiatal hernia and query gastric volvulus. Procedure An emergency laparoscopy was performed which showed a Type-III hiatal hernia through the left and posterior part of hiatal defect. Previous partial fundoplication appears intact with quite a few wrap-to-crura sutures causing significant fibrosis on the right and anterior part of crura. Proximal stomach was reduced. Adhesiolysis was performed to release gastro-oesophageal junction (GOJ) and bleeding controlled by a straight-tip energy device. Improvised sling was used to retract the proximal stomach. GOJ and lower oesophagus was brought below the hiatus. The redundant sac was excised. Posterior crura muscle was repaired using sutures, and partial fundoplication was reconstructed. Check endoscopy showed GOJ below the hiatus with no air leak. The patient made an uneventful recovery progressing to soft diet and was discharged home. A post-operative CT scan showed interval hiatal hernia repair with soft tissue oedema in the region of GOJ without residual hiatal hernia. Conclusion Emergency laparoscopic repair of an acute recurrent Type-III hiatal hernia is safe despite some challenges being encountered in a regional hospital.
Kheng Tian Lim (Fri,) studied this question.
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