The challenge of a giant hiatal hernia

Martin Graversen, MD, Henning K Antonsen, MD, Jan M Krzak, MD

Sygehus Lillebaelt Kolding Denmark

In a highly productive department of abdominal surgery including more than 900 laparoscopic fundoplications and 190 laparoscopic operations for large hiatal hernias, a 72 year old female was offered a laparoscopic operation of a giant hiatal hernia causing severe limitations in her daily life, among others, shortness of breath requiring oxygen supply. The CT- scan showed type IV hernia with totally intra thoracical placed stomach, and parts of pancreas, duodenum, colon, small intestine and omentum. The laparoscopic operation included totally mobilisation of the hiatal sac and organs including necessary resection of the pancreas tail in the right thorax, closing of a 11 cm diaphragmatic defect with a mesh, fundoplication and gastropexia. It was necessary to redo surgery because of a defect in the fundoplication and later because of pancreatitis with an absces, causing mediastinitis, requiring thoracic and abdominal drainage. Chylothorax followed as well. After prolonged hospitalisation, including care in ITU and respiratory support, the patient was discharged with a thoracic drain to the mediastinum, ending in the defect of the stomach, creating a fistula. The stomach defect was closed after 8 month with gastroscopic applied clips and the drain was gradually removed. The patient survived with only mild problems.

A thorough discussion including video clip will be presented.


Session: Poster Presentation

Program Number: P224

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