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Emergency laparoscopic mesh repair of parahiatal hernia

A 71-year-old male was referred to our emergency department with chest pain and foregut obstruction on a background of increasing obstructive symptoms and dyspnoea over the previous months. Prior to presentation, a gastroscopy and barium study (Fig. 1) had been performed and a preoperative diagnosis of paraoesophageal hernia had been made. There was no history of previous diaphragmatic surgery or injury. Laparoscopy revealed a sliding hiatal hernia, but to the left of the hiatal aperture, there was a large parahiatal defect through which a significant portion of the gastric fundus had herniated (Fig. 2). The parahiatal hernia sac was reduced, and both the hiatal pillars and the margins of the parahiatal defect were each approximated separately using interrupted braided polyester sutures (0 Ethibond, Ethicon; Johnson & Johnson, Cincinnati, OH, USA). The whole repair was then reinforced with a light-weight titaniumcoated polypropylene mesh onlay (TiMesh; Biomed Biologics, Nuremberg, Germany) (Fig. 3). The mesh was fixed with helical screws (Protac 5 mm; Covidien, Mansfield, MA, USA). A partial posterior fundoplication was then performed (Figs 2,3). The