Laparoscopic Gastrojejunopexy in Giant and Recurrent Hiatal Hernia Management: A Case Report

BACKGROUND Giant hiatal hernias, whether primary or recurrent, carry substantial risks of complications, including incarceration, ischemia, and necrosis. Early diagnosis and management are essential. Endoscopic gastric decompression facilitates preoperative stabilization by relieving mediastinal compression and gastric ischemia. To prevent recurrence and complications, various techniques have been used to secure the stomach in the abdominal cavity. A combination of esophageal dissection, crural repair, and fundoplication with abdominal wall gastropexy has shown effectiveness; a novel approach - gastrojejunopexy, or the "leash maneuver" - emerged during an emergency operation. This technique demonstrates potential as a method for stomach traction. It may mitigate giant hiatal hernia recurrence, but further studies are required for validation. CASE REPORT A 65-year-old man with obesity (body mass index 33.5 kg/m²) and prior Nissen fundoplication exhibited a giant recurrent hiatal hernia complicated by mediastinal gastric incarceration. Symptoms included dysphagia, regurgitation, thoracic pain, dyspnea, hypotension, and tachycardia. After stabilization with awake endoscopic decompression and fluid/electrolyte imbalance correction, laparoscopic hiatal hernia repair was undertaken. Following crural closure and fundoplication reconstruction, gastrojejunopexy was performed by anchoring a jejunal segment near the ligament of Treitz to the stomach's greater curvature. This maneuver provided downward traction, covered ischemic areas, and reduced recurrence risk. The patient recovered uneventfully, with symptom resolution and no imaging evidence of recurrence at an 8-month follow-up. CONCLUSIONS Gastrojejunopexy appears to be a safe, effective, and technically feasible adjunct to reduce giant hiatal hernia recurrence, particularly in high-risk patients with obesity. Additional studies are necessary to confirm its long-term efficacy and safety.