title: Laparoscopic mesh repair of parahiatal hernia: a case report.
abstract: We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh. A 51-year-old woman presented with vomiting and epigastric pain. CT scan showed a giant paraesophageal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic, making a tension-free primary repair difficult. A laparoscopic mesh repair was performed with a composite mesh, which was covered with the hernia sac to prevent potential erosion into the esophagus or stomach. Recovery was uneventful and the patient was discharged on the 5 days postoperatively. She remained asymptomatic at subsequent follow-up. Laparoscopic repair of parahiatal hernia can be safely performed. In circumstances where a large or fibrotic defect prevents a tension-free primary repair, the use of a composite mesh can provide effective repair of the hernia.
authors.affiliation: Department of Surgery, Changi General Hospital, 2 Simei Street #3, Singapore.
authors.forename: Pei Shi
authors.initials: PS
authors.lastname: Lew
authors.forename: Andrew Siang Yih
authors.initials: AS
authors.lastname: Wong
mesh_terms: D005260:Female; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D013277:Stomach Volvulus / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013526:Surgical Mesh
keywords: Composite mesh; laparoscopic repair; parahiatal hernia