A Case of Large Esophageal Hiatal Hernia Successfully Treated by Laparoscopic Nissen Fundoplication

Akira Ishihara, Yoshihiro Fukoue, Masahiko Murakami^*, Atsushi Sato, Ugen Lee, Koji Otsuka^*, Takashi Kato^* and Mitsuo Kusano^*

Department of Surgery, Shiroyama Hospital Department of Surgery Division of General & Gastroenterological Surgery, Showa University, School of Medicine^*

An 84-year-old woman was admitted to our hospital because of stridorous breathing and appetite loss. An upper gastrointestinal X-ray series demonstrated an inverted stomach. The respiratory symptoms were diagnosed as being secondary esophageal hiatal hernia with gastric volvulus. Antibiotics were temporarily effective in relieving the symptoms of pneumonia, but permanent remission of the respiratory symptoms caused by the hiatal hernia was not achieved by conservative treatment, and laparoscopic surgery was performed. The operation was conducted through four trochars. The hiatus was directly sutured following resection of the hernial sac and Nissen fundoplication was performed. The postoperative course was uneventful, and the respiratory symptoms improved dramatically. Laparoscopic Nissen fundoplication is very useful not only for treating gastroesophageal reflux but for gastric volvulus complicated by esophageal hiatus hernias because it is less invasive and provides good cosmetic results. This procedure will become more popular in Japan in the future.

Key words
esophageal hiatal hernia, gastric volvulus, laparoscopic Nissen fundoplication

Reprint requests
Akira Ishihara Department of Surgery, Shiroyama Hospital 1 Iizuka-cho, Ohta, 373-0817 JAPAN

Accepted
December 19, 2000

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