Laparoscopic Repair of an Incarcerated Esophageal Hiatal Hernia Seven Years after Laparoscopic Total Gastrectomy—A Case Report—

Abstract

A 69-year-old man, who underwent laparoscopic total gastrectomy (LTG) for gastric cancer 7 years earlier and had completed 5 years of follow-up with no recurrence 2 years earlier, presented to the emergency department with acute epigastric pain. Thoraco abdominal computed tomography showed the small intestine protruded into the mediastinum. A diagnosis of incarcerated esophageal hiatal hernia (EHH) was made, and emergency laparoscopic surgery was performed because no signs of bowel perforation or dilation were observed. Intraoperative findings showed that the small intestine including the Y anastomosis protruded into the mediastinum through the widely opened esophageal hiatus. Hernia repair could be performed by pulling out the herniated bowel gently. After reduction of the small intestine, suture cruroplasty and jejunopexy to the diaphragm were performed. There were no postoperative complications, and the patient was discharged on the 9th postoperative day. No recurrence of gastric cancer as well as EHH occurred after 2 years of follow-up. Although EHH incarceration is relatively rare, it may occur even a long time after LTG. Besides taking infraoperative preventive measures for EHH, careful observation considering EHH repair before hernia incarceration is necessary when EHH is found during postoperative follow-up.