VIDEOLAPAROSCOPIC BACKGROUND APPLICATION FOR APPROACHING GIANT hiatus hernia after endoscopic management of stomach VOLVO: CASE REPORT (Atena Editora)

Abstract

According to Allison's classification, hiatal hernia can be divided into four degrees regarding its prolapse, as follows: I or sliding, II or rolling or paraesophageal and type III or mixed. But a fourth type is elucidated in the literature as type IV, known as "giant" or "intrathoracic stomach". Clinical case: A 49-year-old female patient reports postprandial fullness and weight loss. With a recent approach to the endoscopic management of stomach volvulus, a massive hiatus hernia was identified, in addition to Los Angeles grade D esophagitis. Planning: after performing esophageal manometry and phmetry (no changes), the patient was offered a questionnaire about the dyspeptic episodes she had, in order to quantify the loss in quality of life and serve as a parameter in the postoperative period for remission (or control) of the symptoms. Surgical technique: During videolaparoscopy, it was possible to identify that the hiatal hernia was, in fact, giant, comprising the stomach, omentum and transverse colon located in the thoracic cavity. After judicious dissection of the hernial sac and individualization of the structures, it was possible to reduce the abdominal content to its position. A 360º valve was then performed with the bottom of the stomach, followed by narrowing of the diaphragmatic hiatus with interrupted stitches, without tension when passing the orogastric tube. Postoperative: uneventful, with significant improvement of symptoms.