Recurrent Hiatus Hernia With Gastric Volvulus and Postoperative Gastroparesis

30 Jan 2021 09:00 11:00
Melbourne
Matthew Read  Host

Patient Profile & Clinical History

  • Patient: 67-year-old female

  • Initial Condition: Acute gastric volvulus in the setting of a recurrent hiatus hernia.

  • Previous Surgery: The patient had a hiatus hernia repair in a regional country hospital.

  • Recurrence: Represented one year later with hernia recurrence and gastric volvulus.

  • Transfer: Transferred to Metropolitan Hospital (St Vincent’s Hospital, Melbourne) for ongoing management.

Initial Management

  • Endoscopic Management: Underwent endoscopic decompression.

  • Revisional Surgery: Subsequent revisional hiatus hernia repair with 180° posterior fundoplication.

  • Recovery: Recovered well.

Postoperative Course

  • Clinical Course: Multiple emergency department presentations over ensuing months with non-specific gastrointestinal symptoms.

  • Investigation: Gastric emptying and gastroscopy were suggestive of gastroparesis.

  • Treatment: Successfully managed with Botox injection to the pylorus.

Panel of Experts for Discussion

Surgery: Professor Lee L. Swanström, Scientific Director – I.H.U. – Strasbourg

Gastroenterology: Professor Richard W. McCallum, Texas Tech University Health Sciences – El Paso | Dr Chamara Basnayake, St’s Vincent Hospital – Melbourne | Professor Hiroshi Mashimo, Harvard Medical School

Discussion Points

  1. Surgical management of recurrent hiatus hernia

  2. Technical tips and tricks

  3. Active management of gastric volvulus

  4. Investigation and management of gastroparesis following revisional hiatal hernia surgery.