Curtain gastroplasty as an option in high risk emergency hiatus hernia repair

Abstract

We describe a novel surgical technique used in the case of an 86-year-old Caucasian man with multiple comorbidities who presented with upper intestinal obstruction caused by a large paraoesophageal hiatus hernia and concurrent urinary sepsis. The technique, which minimises both operative time and surgical trauma in this situation, uses the fundus of the stomach in a modified Dor anterior fundoplication as a gastric fundoplasty to close the defect. The total operative time was 70 minutes. The patient's recovery was complicated by a lower respiratory tract infection but he was discharged 14 days after surgery with a premorbid oral intake and activity level. We believe this curtain gastroplasty technique represents another surgical option to reduce operative time and trauma in a subgroup of high risk patients presenting with life threatening complications of a large hiatus hernia who have limited physiological reserve and evidence of current ongoing sepsis.