Usah Khrucharoen, Ian T Macqueen, Yijun Chen, Erik P Dutson. UCLA
Minimally-invasive techniques have been implemented in the repair of giant hiatal hernias with successful outcomes; however, recurrence rates have also been reported up to 30 to 40%. In this video, we demonstrated robotic-assisted laparoscopic redo hiatal hernia repair with redo Nissen fundoplication performed at our institution. Patient was a 53-year-old male with a history of laparoscopic repair of giant hiatal hernia with intrathoracic stomach, Nissen fundoplication with PEG tube gastropexy 9 months prior to his current procedure. His PEG tube spontaneously dislodged approximately one week postoperatively. Patient then developed recurrent reflux symptoms 6 weeks post-procedure. Further work up with CT abdomen revealed an evidence of a recurrence of his paraesophageal hiatal hernia measured up to 4.5 cm in craniocaudal dimension. Patient was desirous to proceed with operative management. Following taking down the adhesions and the prior wrap, revision of posterior cruroplasty and Nissen fundoplication was performed. A total of five linear sutured fixation points were used to create a 4-cm-long fundoplication. The superior aspect of the wrap was anchored to the anterior arch of the crura as well as the left and the right crura to prevent the wrap from sliding. In this case, the site of the prior PEG tube was still acting as a point of gastric fixation to the anterior abdominal wall. Operative time was 3 hours and 27 minutes. Blood loss was minimal. Postoperative course was unremarkable. Upper GI series on POD#2 demonstrated no leak, good angulation at His, and intact long wrap below the diaphragm. Patient was initiated clear liquid diet on POD#2 due to residual post-anesthetic nausea. He was discharged on POD#3, and was able to initiate soft diet without difficulty at 2-week postop.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95250
Program Number: V256
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop