Emergency laparoscopic repair of a paraesophageal hernia

A 63-year-old male with a previously documented paraesophageal hernia prese nted with acute severe epigastric pain and bloating. He was taken urgently to the operating room for laparoscopic exploration. The hernia sac was redu ced with difficulty owing to extensive adhesions and the incarcerated porti on of the stomach was mottled and blue. After 10 min of observation the sto mach began to resume a normal appearance. The anterior crura were approxima ted and an anterior gastropexy was performed. The patient was discharged on the 3rd postoperative day and has been asymptomatic since. Paraesophageal hernias with evidence of impending gastric necrosis can be approached lapar oscopically as long as basic principles are observed.