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

Dib V.R.M.; Poggi L.; Madalosso C.A.S.; de Melo P.R.R.E.; Ramos A.C.; Antozzi L.; Fin A.S.; Ribeiro R.; Júnior H.O.; Volpe P.; Domene C.E.; Braghetto I. · American Journal of Case Reports (2025) · DOI: 10.12659/ajcr.950114

Resumen

Objective: Background: Case Report: Conclusions: Unusual clinical course Giant hiatal hernias, whether primary or recurrent, carry substantial risks of complications, including incarcera-tion, 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 cav-ity. 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 miti-gate giant hiatal hernia recurrence, but further studies are required for validation. 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 je-junal segment near the ligament of Treitz to the stomach’s greater curvature. This maneuver provided down-ward 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. 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. © Am J Case Rep, 2025;.

Instituciones: Universidad Nacional Mayor de San Marcos