Surgical Technique and Difficult Situations from Bernard Dallemagne

Abstract

Large hiatal hernias may cause a large variety of symptoms and controversy still exists regarding the indication for surgical repair. Upside-down stomach represents a rare type of hiatal hernia with complete gastric herniation or herniation of most of the stomach into the thoracic cavity with organoaxial twist. This condition could potentially lead to gastric volvulus which carries the risk of life-threatening complications such as bleeding, strangulation, and perforation. Patients usually complain of mechanical symptoms such as dysphagia, chest pain, shortness of breath, and anemia rather than reflux symptoms. We support the idea that surgical management should be offered only to symptomatic patients bearing in mind that upon thorough questioning most patients will report some symptoms. Asymptomatic patients should be followed carefully and should be operated on if symptoms develop.