Laparoscopic Hiatal Herniorrhaphy in a Large Hiatal Hernia as a Rare Cause of Dyspnea and Anemia: A Case Report

Herniation of the stomach through the esophageal hiatus into the thoracic cavity is a common affliction in modern humans. Its incidence in North America has ranged from 10% to 80%. However, approximately complete herniation of the stomach is scarce. Therefore, we discussed this unusual case. A 43-year-old man with a hypochromic, microcytic, iron-deficient anemia picture, postprandial and postexercise respiratory failures, and epigastric pain was examined by a gastroenterologist in the outpatient clinic of mother and child specialized hospital in Shiraz, Iran in November 2015. Left thorax hemiatrophy was obvious upon physical examination. Positive Helicobacter pylori, peripyloric erythema, and mild chronic active gastritis were diagnosed after an upper gastrointestinal (GI) endoscopy and colonoscopy. In a barium-swallow upper GI series, malrotation of most of the patient’s stomach and the stomach’s dislocation in to the thoracic cavity were detected. A CT scan also showed a large hiatus hernia with a large part of the stomach inserted in the defect. The patient revealed a history of a motorcycle accident about 28 years earlier. After the administration of general anesthesia and the semilateral positioning of the patient, five ports were inserted (three 5 mm and two 10 mm). The stomach was relocated into the abdominal cavity, and the bloody sac was dissected from the left and then the right cross, detached from the thoracic cavity, and completely removed. Two cruses were sutured together using a 1/0 silk suture, and after releasing the short gastrics, a prophylactic Dor fundoplication was performed. The next morning, oral nutrition was started, and the patient was discharged in a good general health condition. Laparoscopic repair of a large hiatus hernia plus Dor fundoplication is an effective method of treatment of such a defect without any symptoms. However, it may be associated with the mild to moderate prevalence of recurring hernias.