Acute transhiatal migration and herniation of fundic wrap following laparoscopic nissen fundoplication

Acute transhiatal wrap herniation can occur in the early postoperative period following laparoscopic Nissen fundoplication due to events which can raise intra-abdominal pressure. Of a total of 264 patients who underwent laparoscopic Nissen fundoplication in our series, two developed acute transhiatal wrap herniation, 8 and 12 weeks after the procedure, respectively. Prompt referral to our unit with early diagnosis and laparoscopic reduction of the hernia resulted in an uneventful recovery in one patient. Delay in recognition and referral for the other patient resulted in strangulation and perforation of the stomach in the posterior mediastinum, necessitating laparotomy and resection of the gastric fundus. Awareness and a high index of suspicion are necessary to detect and treat the condition early, thereby averting a potentially life-threatening clinical situation. Herniation, if detected early, can be treated by the laparoscopic approach. Satisfactory outcomes in the management of wrap migration following laparoscopic Nissen fundoplication hinge on early recognition and prompt surgical intervention. It is important to recognize and prevent factors that lead to anatomical failure of the operation. Methods to fix the fundic wrap and the benefits of using prosthetic material for crural repair need to be considered.