Surgical management of hiatus hernia with chronic gastric volvulus: report of two cases

Totally intrathoracic gastric volvulus is an uncommon presentation of hiatus hernia. We report herein two patients of hiatus hernia repair with mesenteroaxial gastric volvulus who presented as so-called upside-down stomach, which resulted in excellent clinical outcomes. The two patients underwent an attempted laparoscopic floppy Nissen fundoplication. In patient 1, the duodenum severely adhered to the hernia sac and converted to an open Nissen fundoplication. The operating time for patient 1 and patient 2 was 224 and 232 min, respectively. No postoperative morbidities occurred. At a follow-up of 18 and 2 months, the two patients had not had a relapse or any of their prior symptoms. The repair of an esophageal hiatus hernia with chronic gastric volvulus can be accomplished successfully and safely with an open or laparoscopic approach. Because this condition occurs more frequently in the elderly, an attempt to perform laparoscopic surgery may contribute to minimal invasive treatment.