Skip to main content

Surgical management of hiatus hernia with chronic gastric volvulus: report of two cases

Abstract

Totally intrathoracic gastric volvulus is an uncommon presentation of hiatus hernia. We report herein two patients of hiatus hernia repair with mesenteroaxial gastric volvulus who presented as so-called upside-down stomach, which resulted in excellent clinical outcomes. The two patients underwent an attempted laparoscopic floppy Nissen fundoplication. In patient 1, the duodenum severely adhered to the hernia sac and converted to an open Nissen fundoplication. The operating time for patient 1 and patient 2 was 224 and 232 min, respectively. No postoperative morbidities occurred. At a follow-up of 18 and 2 months, the two patients had not had a relapse or any of their prior symptoms. The repair of an esophageal hiatus hernia with chronic gastric volvulus can be accomplished successfully and safely with an open or laparoscopic approach. Because this condition occurs more frequently in the elderly, an attempt to perform laparoscopic surgery may contribute to minimal invasive treatment.

This is a preview of subscription content, access via your institution.

References

  1. Berti A. Singolare attortihliamento dele’esophago col duodeno sequita da rapida motre. Gass Med Ital 1866;9:139.

    Google Scholar 

  2. Berg J. Zwei Falle von axendrehung des magens operation; heilung. Nord Med Arkiv 1897;30:1.

    Google Scholar 

  3. Palanivelu C, Rangarajan M, Shetty AR, Senthilkumar R. Laparoscopic suture gastroplexy for gastric volvulus: a report of 14 cases. Surg Endosc 2007;21:863–866.

    Article  PubMed  Google Scholar 

  4. Perdikis G, Hinder RA, Filipi CJ, Walenz T, McBride PJ, Smith SL, et al. Laparoscopic paraesophageal hernia repair. Arch Surg 1997;132:586–589.

    CAS  PubMed  Google Scholar 

  5. Iannelli A, Fabiani P, Karimdjee BS, Habre J, Lopez S, Gugenheim J. Laparoscopic repair of intrathoracic mesenterioaxial volvulus of the stomach in an adult: report of a case. Surg Today 2003;33:761–763.

    Article  PubMed  Google Scholar 

  6. Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation? Ann Surg 2002;236:492–500.

    Article  PubMed  Google Scholar 

  7. Haas O, Rat P, Christophe M, Friedman S, Favre JP. Surgical results of intrathoracic gastric volvulus complicating hiatal hernia. Br J Surg 1990;77:1379–1381.

    Article  CAS  PubMed  Google Scholar 

  8. Okabe T, Watanuki F, Ohwada S, Morishita Y. An esophageal hiatal hernia associated with heart failure, gallbladder perforation and mesenteroaxial gastric volvulus: a case report. Jpn J Gastroenterol Surg 2006;39:1797–1802.

    Google Scholar 

  9. Carter R, Brewer LA 3rd, Hinshaw DB. Acute gastric volvulus. A study of 25 cases. Am J Surg 1980;140:99–106.

    Article  CAS  PubMed  Google Scholar 

  10. Spechler SJ. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The department of veterans affairs gastroesophageal reflux disease study group. N Engl J Med 1992;326:786–792.

    CAS  PubMed  Google Scholar 

  11. Frantzides CT, Carlson MA. Laparoscopic versus conventional fundoplication. J Laparoendosc Surg 1995;5:137–143.

    CAS  PubMed  Google Scholar 

  12. Katkhouda N, Mavor E, Achanta K, Friedlander MH, Grant SW, Essani R, et al. Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery (St. Louis) 2000;128:784–790.

    Article  CAS  Google Scholar 

  13. Carlson MA, Frantzides CT. Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases. J Am Coll Surg 2001;193:428–439.

    Article  CAS  PubMed  Google Scholar 

  14. Strate U, Emmermann A, Fibbe C, Layer P, Zornig C. Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 2008;22:21–30.

    Article  CAS  PubMed  Google Scholar 

  15. Yano F, Stadlhuber RJ, Tsuboi K, Gerhardt J, Filipi CJ, Mitta SK. Outcomes of surgical treatment of intrathoracic stomach. Dis Esophagus 2009;22:284–288.

    Article  CAS  PubMed  Google Scholar 

  16. Channer LT, Squires GT, Price PD. Laparoscopic repair of gastric volvulus. J Surg Laparosc Surg 2000;4:225–230.

    CAS  Google Scholar 

  17. Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, et al. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 2006;20:159–165.

    Article  CAS  PubMed  Google Scholar 

  18. Pearson FG. Massive hiatal hernia with incarceration: a report of 53 cases. Ann Thoracic Surg 1983;35:45–51.

    CAS  Article  Google Scholar 

  19. Fuller CB, Hagen JA, DeMeester TR, Peters JH, Ritterr M, Bremner CG. The role of fundoplication in the treatment of type II paraesophageal hernia. J Thorac Cardiovasc Surg 1996;111:655–661.

    Article  CAS  PubMed  Google Scholar 

  20. Carlson M, Condon RE, Ludwig KA, Shulte WJ. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 1998;187:227–230.

    Article  CAS  PubMed  Google Scholar 

  21. Tsang TK, Walker R, Yu DJ. Endoscopic reduction of gastric volvulus: the alpha-loop maneuver. Gastrointest Endosc 1995;42:244–248.

    Article  CAS  PubMed  Google Scholar 

  22. Ghosh S, Palmer KR. Double percutaneous endoscopic gastrostomy fixation: an effective treatment for recurrent gastric volvulus. Am J Gastroenterol 1993;88:1271–1272.

    CAS  PubMed  Google Scholar 

  23. Baudet JS, Armengol-Miró JR, Medina C, Accarino AM, Vilaseca J, Malagelada JR. Percutaneous endoscopic gastrostomy as a treatment for chronic gastric volvulus. Endoscopy 1997;29:147–148.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Toru Obuchi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Obuchi, T., Sasaki, A., Nakajima, J. et al. Surgical management of hiatus hernia with chronic gastric volvulus: report of two cases. Esophagus 7, 59–63 (2010). https://doi.org/10.1007/s10388-009-0219-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10388-009-0219-7

Key words

  • Laparoscopy
  • Gastric volvulus
  • Hiatus hernia
  • Fundoplication
  • Upside-down stomach