Laparoscopic mesh repair and Toupet fundoplication for parahiatal hernia complicated by sliding hiatal hernia: A case report.

INTRODUCTION: The parahiatal hernia is a rare type of diaphragmatic hernia in adults. Although there have been occasional reports of parahiatal hernias, few have reported simultaneous laparoscopic mesh repair of a parahiatal hernia with a hiatal hernia. This report describes laparoscopic mesh repair and fundoplication for a parahiatal hernia combined with an esophageal hiatal hernia. PRESENTATION OF CASE: A 39-year-old woman presented with left-side postprandial abdominal pain. Esophagogastroduodenoscopy revealed a parahiatal hernia and sliding hiatal hernia. Computed tomography (CT) showed that the stomach had prolapsed into the thorax from the outside of the left diaphragm. The preoperative diagnosis was parahiatal hernia with a hernial sac complicated by sliding hiatal hernia. Laparoscopic mesh repair was planned. The stomach had prolapsed on the left side of the esophagus and was extruded. The diagnosis of a parahiatal hernia with a hernial sac complicated by a sliding hiatal hernia was confirmed. The esophageal hiatal hernia was repaired using two non-absorbable sutures. The congenital defect was further reinforced with mesh fixed to the orifice of the adjacent parahiatal hernia. We performed Toupet fundoplication to treat gastroesophageal reflux disease and sutured the right diaphragmatic crus and stomach to prevent migration. The patient was discharged home on postoperative day 5.
CONCLUSION: We encountered a patient with a parahiatal hernia complicated by a sliding hiatal hernia. The parahiatal hernia can be diagnosed by CT imaging. Preoperative diagnostic imaging can lead to appropriate treatment.