Surgical Endoscopy

, Volume 27, Issue 8, pp 3000–3002 | Cite as

Aortic injury during laparoscopic esophageal hiatoplasty

  • Oscar Cano-ValderramaEmail author
  • Almudena Marinero
  • Andrés Sánchez-Pernaute
  • Inmaculada Domínguez-Serrano
  • Elia Pérez-Aguirre
  • Antonio J. Torres
Dynamic Manuscript


A 75-year-old female patient with a type III hiatal hernia was submitted to laparoscopic mesh hiatoplasty. Soon after the last suture fixed the mesh to the left crura, a hemorrhage was observed. Conversion to open surgery was not performed. The most common sources of bleeding (liver, phrenic arteries, crura, spleen, and short gastric vessels) were discarded as the cause of the hemorrhage. The mesh was set free in order to explore the lower mediastinum. The source of the hemorrhage was identified: it was the last suture fixing the mesh to the left crura, which was found passing through the aortic wall. The hemorrhage stopped as soon as the suture was removed. When facing a hemorrhage during this kind of surgery, it is essential to be methodical to discover the source of the bleeding. First of all, the most common sources of bleeding must be checked out. Injury of the inferior vena cava must also be ruled out, because it is an uncommon but potentially lethal complication. Afterwards, the lower mediastinum must be explored. Conversion to an open approach is needed if the patient becomes unstable or the surgeon does not have enough laparoscopic skills to find and solve the bleeding. Most of the reported cases of aortic injury during laparoscopic hiatoplasty are secondary to vascular injuries during port insertion. When a suture is the cause of bleeding, the removal of the stitch should be enough to stop the bleeding. If there is a tear of the aortic wall, a patch should be employed for the repair. In conclusion, left crura and thoracic aorta are very close to one another. The surgeon must be very careful when working near the left crura, mostly in old patients with a dilated and aneurysmatic aorta.


GORD/GERD (gastro-oesophageal reflux disease) Oesophageal Complications Barrett-s oesophagus 



Drs. Cano-Valderrama, Marinero, Sánchez-Pernaute, Domínguez-Serrano, Pérez-Aguirre, and Torres have no conflict of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 147414 kb)


  1. 1.
    Watson DI, de Beaux AC (2001) Complications of laparoscopic antireflux surgery. Surg Endosc 15:344–352PubMedCrossRefGoogle Scholar
  2. 2.
    Perdikis G, Hinder RA, Lund RJ, Raiser F, Katada N (1997) Laparoscopic Nissen fundoplication: where do we stand? Surg Laparosc Endosc 7:17–21PubMedCrossRefGoogle Scholar
  3. 3.
    Hinder RA, Filipi CJ, Wetscher G, Neary P, DeMeester TR, Perdikis G (1994) Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 220:472–481PubMedCrossRefGoogle Scholar
  4. 4.
    Coelho JC, Wiederkehr JC, Campos AC, Andrigueto PC (1999) Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease. J Am Coll Surg 189:356–361PubMedCrossRefGoogle Scholar
  5. 5.
    Roviaro GC, Varoli F, Saguatti L, Vergani C, Maciocco M, Scarduelli A (2002) Mayor vascular injuries in laparoscopic surgery. Surg Endosc 16:1192–1196PubMedCrossRefGoogle Scholar
  6. 6.
    Yano F, Omura N, Tsuboi K, kashiwagi H, Yanaga K (2008) Thoracic aortic injury during laparoscopic fundoplication for reflux esophagitis. Int J Surg 6:490–492PubMedCrossRefGoogle Scholar
  7. 7.
    Legget PL, Bissell CD, Churchman-Winn R (2002) Aortic injury during laparoscopic fundoplication: an underreported complication. Surg Endosc 16:362CrossRefGoogle Scholar
  8. 8.
    Escrig Sos J, Polo Lorduy A, Miralles Tena JM, Gibert Gerez J, Molina Martinez J (2009) Mediastinal aortic injury during laparoscopic surgery of the esophageal hiatus. Cir Esp 85:124–126PubMedCrossRefGoogle Scholar
  9. 9.
    Zügel N, Lang RA, Kox M, Hüttl TP (2009) Severe complication of laparoscopic mesh hiatoplasty for paraesophageal hernia. Surg Endosc 23:2563–2567PubMedCrossRefGoogle Scholar
  10. 10.
    Baigrie RJ, Watson DI, Game PA, Jamieson GC (1997) Vascular perils during laparoscopic dissection of the oesophageal hiatus. Br J Surg 84:556–557PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Oscar Cano-Valderrama
    • 1
    Email author
  • Almudena Marinero
    • 2
  • Andrés Sánchez-Pernaute
    • 1
  • Inmaculada Domínguez-Serrano
    • 1
  • Elia Pérez-Aguirre
    • 1
  • Antonio J. Torres
    • 1
  1. 1.Department of SurgeryHospital Clínico San CarlosMadridSpain
  2. 2.Department of GastroenterologyHospital Universitario de La PrincesaMadridSpain

Personalised recommendations