Eun Young Kim, MD. Division of Gastrointestinal Surgery, Department of Surgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea
We herein report two cases of emergency laparoscopic surgery in adult patients with massive organ herniation into thoracic cavity.
A 43 years old female with one day history of epigastric pain admitted in the emergency room. She also complained of nausea and vomiting. She had no past medical and trauma history. On the imaging study, the diagnosis is Left diaphragmatic hernia. The name of operation is laparoscopic repair of diaphragmatic hernia with dual mesh. There was a huge defect of posterolateral aspect of diaphragm. We have done reduction of all of the herniated organs with grasper. Herniated organs were a part of stomach, omentum, transverse colon, and Spleen. After that, adhesive band and tissues were resected with ultrasonic energy device. At the same time, hernia sac was dissected and removed. Dual mesh was used and fixed it using tacker device. The patient discharged in postoperative day 8 without any problem.
A 83 years old female with one week history of aggravation of left flank pain admitted in the emergency room. She had diabetes and hypertension. On the imaging study, the diagnosis is hiatal hernia with gastric volvulus. The name of operation is laparoscopic reduction of gastric volvulus and nissen fundoplication. At first, we opened the fars flaccida and exposed the crus muscle. We have done reduction of all of the herniated organs with grasper. We extracted the omentum and stomach. The stomach was folded intricately and rolled up into thoracic cavity. In the middle of the procedure, adhesive band and tissues were resected with ultrasonic energy device. And hernia sac was dissected and removed. The mobilization of the gastric fundus was done through the separation from the short gastric vessels. Pulling the string wrapped in esophagus, one stitch of suture was done to make crural closure. Because the hiatal defect was too big to do primary closure, we used dual mesh. The extra-space of mesh was trimmed with scissor. Finally we fixed it using tacker device. After that, Shoeshine maneuver was performed using atraumatic grasper. Fundoplication was done in good position without tension. Esophago-gastric fixation was also performed. The patient discharged in postoperative day 12 without any problem.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87673
Program Number: V182
Presentation Session: Wednesday Video Loop (Non CME)
Presentation Type: VideoLoop