Type IV hiatal hernia post laparoscopic Nissen fundoplication: Report of acase

A postoperative hiatal hernia is a rare but serious complication of fundopl ication. We report herein a 62-year-old female who presented with abdominal pain and vomiting 2 years following laparoscopic Nissen fundoplication. At laparotomy, the stomach and the transverse colon were intrathoracic (type IV hiatal hernia); the esophageal hiatus was markedly dilated with no evide nce that they had been approximated. At 18 months follow-up, she is doing v ery well apart from occasional heartburn. A high index of suspicion is need ed to diagnose postoperative hiatal hernias. A routine closure of the crura with nonabsorbable suture material and an avoidance of iatrogenic pneumoth orax may help to reduce the occurrence of this problem.