Laparoscopic-assisted Thoracotomy for Intrathoracic Stomach: A Hybridized Approach

Joel R Brockmeyer, MD1, Andrew D Van Osdol, MD1, Venki Paramesh, MD2, Shanu N Kothari, MD2. 1Gundersen Medical Foundation, 2Gundersen Health System

INTRODUCTION: Hiatal hernias are a common within the United States, with up to 60% of the population having some degree of herniation, depending on age. Most are asymptomatic. Laparoscopic repair of hiatal hernias has quickly become the most common technique for repair. This technique may be performed with or without mesh reinforcement of the crural closure. Occasionally, transthoracic approaches are utilized, especially when a shortened esophagus is expected. Unfortunately, the radiographic recurrence rate for hiatal hernias is about 50%. Fortunately, the symptomatic recurrence rate requiring reoperation is far less. Only about 3-5% of patients develop symptoms requiring reoperation.

CASE SUMMARY: We present the case of a 53-year-old female who underwent multiple hiatal hernia repairs for symptomatic reflux. Her second surgery at an outside hospital was complicated by cardiac tamponade. Her complicated course eventually required a laparoscopic-assisted thoracotomy for lysis of adhesions, reduction of the intrathoracic stomach and repair of the crural defect. The techniques for the surgery are discussed.

CONCLUSIONS:  Revisional hiatal hernia repair can be challenging. Knowledge of proper tissue planes is imperative. Thoracotomy can be used in rare cases to assist in mobilization and dissection. 

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