腹腔鏡下手術が有効であった胃と結腸の脱出を伴う巨大食道裂孔ヘルニアの１例

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  • A CASE OF LARGE ESOPHAGEAL HIATAL HERNIA WITH THE HERNIATED STOMACH AMD COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC NISSEN FUNDOPLICATION

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We report a case of large esophageal hiatal hernia with the herniated stomach and transverse colon.<br> A 75-year-old woman was admitted to the hospital because of worsening of dysphasia, recurrent aspiration peumonia and symptoms of intestinal obstruction. She had been medicated under the diagnosis of gastroesophageal reflux disease at prior hospital for 7 years. Following close examinations, she was found to have an esophageal hiatal hernia with the herniated stomach and transverse colon in the left pleural cavity which pressed the esophagus to cause dysphasia and aspiration pneumonia. We performed a laparoscopic surgery. After the hernia sac was excised up to the oral side as possible as we could, the stomach and transverse colon were easily reduced into the abdominal cavity. The esophageal hiatus was directly sutured and a Nissen fundoplication was performed, when the gastric fornix was fixed to the diaphragm and its crus by sutures to prevent sliding. The postoperative course was uneventful with good food ingestion. The stomach and transverse colon were confirmed to be in their proper positions by examinations. The patient was discharged from the hospital on the 12th postoperative day. Laparos-copic hiatal closure followed by Nissen fundoplication seems to be an effective procedure even for large esophageal hiatal hernia with the herniated stomach and transverse colon.

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