A Case of Esophageal Hiatal Hernia Showing an Upside-down Stomach Treated by Laparoscopic Mesh-Repair with Toupet fundoplication

Abstract

A 72-year-old woman presented to our hospital after experiencing a tightening chest pain and vomiting for a few days. A CT scan revealed that the stomach was located in the mediastinum, and an upper gastrointestinal endoscopy showed an obstruction of the prolapsed stomach (an attempt at reduction was unsuccessful). These findings prompted a diagnosis of Type Ⅲ esophageal hiatal hernia with an inverted upside-down stomach. Therefore, we decided on a laparoscopic repair. The hiatal hernia defect was closed with nonabsorbable sutures, and the crural repair site was reinforced with composite mesh. Additionally, Toupet fundoplication was performed. After these interventions, no recurrence of her symptoms occurred after a year. In most cases, laparoscopic surgery is the choice for repair of hiatal hernia with an inverted upside-down stomach, but the addition of fundoplication is controversial. We report a case of esophageal hiatal hernia showing an inverted upside-down stomach treated by laparoscopic mesh-repair with Toupet fundoplication.