Immediate Postoperative Recurrence of a Large Hiatus Hernia After Laparoscopic Nissen Fundoplication Without Suture Disruption: A Case Report

Vollständiger Abstract

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Background: Recurrence of a repaired hiatus hernia after antireflux surgery is a well-recognised late complication, but recurrence within the first 24 hours, without disruption of the crural or wrap sutures, is exceptionally rare. Case Presentation: A 28-year-old man underwent laparoscopic Nissen fundoplication with hiatal repair for a large hiatus hernia with severe gastroesophageal reflux disease. Three crural sutures (Ethibond 2-0) were placed and a 360-degree wrap fashioned over a 40 French bougie, with the wrap anchored to the right crus. Despite prophylactic intravenous antiemetics, the patient developed repeated retching and vomiting in the early postoperative period, followed by chest discomfort and pain the next morning. Chest radiography demonstrated an intrathoracic gastric shadow with an air-fluid level, confirming acute recurrence. At emergency redo laparoscopy, the wrap and stomach had herniated into the chest through the hiatus while hinged at the right crus, with all primary sutures found intact. A more extensive repair using six crural sutures without mesh reinforcement was performed, and the patient recovered uneventfully. Conclusion: Forceful early postoperative retching can generate sufficient transdiaphragmatic pressure to herniate an intact wrap and stomach into the chest without any suture failure, distinguishing this mechanism from the more commonly reported suture-line disruption. A high index of suspicion, aggressive antiemetic prophylaxis, and prompt imaging in symptomatic patients allow early recognition and successful laparoscopic redo repair even without mesh.