VS02.09: LAPAROSCOPIC REPAIR OF RECURRENT TYPE IV PARAESOPHAGEAL HERNIA WITH COLLIS GASTROPLASTY

Abstract

Abstract Description Laparoscopic Repair of Recurrent Type IV Hiatal Hernia with Collis Gastroplasty In this case, we present a laparoscopic repair of a large, recurrent type four paraesophageal hernia with a Collis Gastroplasty. The patient presented 4 months after repair of an initial hernia at a separate facility with primary hiatal closure without an anti-reflux procedure. Intra-operatively, there was a giant type IV hernia with the transverse colon and the majority of the stomach in the right chest with an organ-oaxial volvulus. The colon and omentum were easily reducible, but the stomach was densely adherent within the right chest. After extensive dissection, the stomach was able to be reduced into the abdomen, but only two centimeters of intra-abdominal esophagus remained and a Collis gastroplasty was performed. A Nissen fundoplication was then performed at the end of the case. This case demonstrates three unique findings. The first is the short time to recurrence after a prior repair without any establishment of an anti-reflux barrier. The second is the unusual hernia with the majority of the stomach located in the right chest. Finally, this video demonstrates the technique of a laparoscopic Collis gastroplasty with a wedge fundectomy technique given the intra-operative findings of a short esophagus. This technique is a reproducible approach that creates a neo-esophagus that can be considered when there is axial tension after full mobilization of the esophagus. Identification of optimal location for stapler placement is facilitated by concurrent laparoscopy with endoscopic identification of the gastroesophageal junction. Disclosure All authors have declared no conflicts of interest.