Postoperative obstruction of recurrent esophageal hiatal hernia: A case report

Surgical repair is considered the optimal treatment for hiatal hernia (HH); however, postoperative complications, such as obstruction, can occur, which may complicate recovery. This case report details a patient who experienced postoperative obstruction following laparoscopic adhesiolysis combined with transabdominal HH repair and Nissen fundoplication for recurrent esophageal HH.

A 64-year-old female presented with a 3-year history of worsening shortness of breath during physical activity. She also reported upper abdominal pain, postprandial vomiting, and difficulty swallowing, all of which significantly compromised her quality of life. The patient had a 5-year history of diabetes, with no notable family or genetic history. Three years prior, she underwent laparoscopic HH repair at a local hospital, but specific details of that surgery were not available.

HH was confirmed through computed tomography scans of the chest and upper abdomen, as well as serial examinations of the upper digestive tract.

On March 9, 2023, the patient underwent laparoscopic abdominal adhesion release, transabdominal HH repair, and Nissen fundoplication. Postoperatively, she received parenteral nutrition, acid inhibition, and symptomatic treatment for deswelling to alleviate abdominal pain and vomiting. However, the patient was unable to tolerate oral intake due to obstruction.

A contrast study revealed high obstruction at the distal esophagus, specifically at the junction of the stomach and esophagus, likely at the cardia. Subsequently, on April 6, 2023, the patient underwent a second laparoscopic exploration and adhesiolysis under general anesthesia. Postoperatively, the patient recovered well and was discharged on April 14, 2023. During the 12-month follow-up on April 30, 2024, she reported returning to normal daily activities with no complaints of discomfort.

This case highlights that laparoscopic adhesiolysis combined with transabdominal HH repair and Nissen fundoplication can effectively address recurrent esophageal HH along with postoperative obstruction. The findings provide important insights for the individualization of surgical procedures for patients with HH.