Laparoscopic Sleeve Gastrectomy As a Treatment Option for Acute Gastric Fundus Necrosis After Laparoscopic Redo Paraesophageal Hernia Repair and Slipped Redo Nissen Fundoplication

Introduction: This video illustrates the use of laparoscopic techniques to resolve an acute gastric fundus necrosis after laparoscopic redo Paraesophageal Hernia Repair (PHR) and redo Nissen Fundoplication (NF) for a slipped NF.

Case Report: A sixty six-year-old female 24 hours status post a redo procedure for recurrent paraesophageal hernia with slipped NF and high-grade dysphagia, who presents with CT Scan showing large pleural effusion, worsening of the respiratory status and an upper gastro intestinal series showing contrast extravasation. The patient underwent a diagnostic laparoscopy. During the procedure the fundoplication was taken down, identifying two areas of perforation of the gastric fundus, most likely due to ischemic necrosis. A 32-French Ewald tube was passed into the distal stomach, and with the aid of a green cartilage linear stapler, the stomach was vertically transected, and the gastric fundus resected. The staple line was reinforced with a running 2-0 absorbable suture and a sub hepatic drain was placed as well.

Results: The patient tolerated the procedure well. The postoperative course was remarkable for a slow recovery of the pulmonary status. The patient was started on oral feeds on postoperative day # 3 and was discharged home on postoperative day #17. The long term follow-up and recovery were uneventful.

Conclusion: Acute gastric necrosis after PHR and NF is an unusual complication resulting most likely due to an error in judgment. Early recognition and surgical treatment are paramount to decrease mortality. The laparoscopic approach and sleeve gastrectomy are feasible options in the management of this complication.

Session: Podium Video Presentation

Program Number: V025

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