Robotic repair of a parahiatal hernia with gastric volvulus

Parahiatal hernias are rare and distinct subtype of diaphragmatic hernia, which is very difficult to diagnose clinically. Laparoscopic repair has been reported in the literature. We report a case of parahiatal hernia with gastric volvulus, which was repaired successfully by robotic surgery along with gastropexy. We present the case of a 50-year-old male who presented with vomiting and epigastric pain. His CT scan showed a giant parahiatal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic and large, making a tension-free primary repair difficult. A prolene mesh repair was done and two point gastropexy to the anterior abdominal wall was performed robotically. Recovery was uneventful and the patient was discharged on the 5th postoperative day. He remained asymptomatic at subsequent follow-up. Robotic repair of parahiatal hernia can be safely performed with advantage of robotic surgery in this difficult access area. In circumstances where a large defect prevents a tension-free primary repair, the use of a mesh can provide effective repair of the hernia defect.