S. Julie-Ann Lloyd, MD, PhD, Gautam Sharma, MD, Jacob A Petrosky, MD, John H Rodriguez, MD, Jeffrey L Ponsky, MD, Matthew D Kroh, MD. Section of Surgical Endoscopy, Dept. of General Surgery, Cleveland Clinic
Minimally invasive paraesophageal hernia repair has shown excellent symptom improvement, but is associated with a relatively high rate of radiographic recurrence. In the setting of dense adhesion formation, reoperation can be particularly challenging. We present the case of a 56 year-old morbidly obese female with a history of a remote laparoscopic paraesophageal hernia repair with gastroplasty and fundoplication. At the time of presentation, the patient had clinical and radiographic evidence of recurrence, including wrap disruption and transhiatal migration. Laparoscopic revision involved extensive adhesiolysis, reversal of the fundoplication and closure of the hiatus. Reconstruction was completed with conversion to Roux-en-Y anatomy with a small gastric pouch. After an unremarkable post-operative course, the patient was discharged on the fifth day. Laparoscopic conversion to a Roux-en-Y reconstruction is a safe and technically feasible option for morbidly obese patients with failure of anti-reflux surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80496
Program Number: V046
Presentation Session: Thursday Exhibit Hall Video Presentations Session 3 (Non CME)
Presentation Type: EHVideo