Hand-assisted laparoscopic surgery for an esophageal hiatal hernia with incarcerated transverse colon presenting after laparoscopic gastrectomy: a case report

Abstract

Background Esophageal hiatal hernia (EHH) presenting after gastrectomy for carcinoma is a type of internal hernia and very rare. There have been no published reports on the use of hand-assisted laparoscopic surgery (HALS) for the treatment of an incarcerated EHH that presented after a gastrectomy. Herein, we report a rare case of HALS performed for an incarcerated EHH presenting after a laparoscopic gastrectomy. Case presentation This case report presents the case of a 66-year-old man who underwent hernia repair for an incarcerated hernia that presented after he underwent a laparoscopic proximal gastrectomy with double-tract reconstruction for cancer in the esophagogastric junction. Emergency laparoscopic hernia repair was performed and herniation of the transverse colon into the left thoracic cavity through a hiatal defect was confirmed. Since it was difficult to return the transverse colon into the abdominal cavity using forceps, the procedure was converted to HALS and the transverse colon was pulled back into the abdominal cavity. The hernia defect was closed using a non-absorbable suture. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. Conclusions The HALS approach provides the tactile experience of an open surgery combined with the benefits of a laparoscopic procedure such as good visualization and low invasiveness. In this case, when the transverse colon that had herniated into the left hemithorax was returned to the abdominal cavity, damage to the transverse colon was avoided by using the hand. Hence, HALS was safely performed to repair an incarcerated EHH after gastrectomy.

Strangulated Bowel Obstruction Due to Hiatal Hernia After Laparoscopic Total Gastrectomy

“…In a Japanese retrospective study of 8,938 patients who underwent gastrectomy for gastric cancer, only 13 (0.19%) were diagnosed with internal hernias, with only one case (0.01%) considered to be an esophageal hiatal hernia [9]. To date, six cases of strangulated intestinal obstruction due to esophageal hiatal hernia incarceration have been reported [11][12][13][14][15][16]. Including this case, we present seven cases in Table 1 (modified from Itamoto et al [16]).…”

“…This suggests that generalized muscle weakening and a decrease in intraabdominal fat might have enlarged the esophageal hiatus, thereby increasing the risk of intestinal herniation. Itamoto et al [16] similarly reported that weight loss could be the risk factor for esophageal hiatal hernia. Additionally, the absence of adhesions due to laparoscopic surgery may have further increased the risk of internal hernias.…”

“…To date, six cases of strangulated intestinal obstruction due to esophageal hiatal hernia incarceration have been reported [11][12][13][14][15][16]. Including this case, we present seven cases in Table 1 (modified from Itamoto et al [16]). All cases were male.…”