Doctors have successfully treated a rare and potentially life-threatening case of paraesophageal hernia with gastric volvulus in a 61-year-old woman using advanced robotic surgery.
Patient's Condition
The patient had been suffering from severe upper abdominal and lower chest pain for nearly eight months. Symptoms worsened after meals and were relieved only after vomiting. Despite multiple emergency visits and repeated treatment for acidity and acid-peptic disease, the pain continued to recur, significantly affecting her quality of life.
Diagnosis
Upon detailed evaluation, doctors identified a large paraesophageal hiatus hernia, a condition in which a significant portion of the stomach migrates from the abdomen into the chest cavity through an opening near the food pipe. Further imaging revealed an additional complication: gastric volvulus, or twisting of the stomach, which can lead to obstruction, strangulation, reduced blood supply, and gangrene if left untreated.
Surgical Procedure
The patient underwent robotic-assisted paraesophageal hernia repair with gastropexy under general anaesthesia. The procedure involved repositioning the stomach into the abdomen, releasing dense adhesions, repairing the enlarged diaphragmatic opening, and securing the stomach in place to prevent recurrence. The case presented significant technical challenges, including dense adhesions between the stomach, esophagus, and diaphragm, along with substantial displacement of the stomach into the chest cavity.
Expert Comments
Commenting on the case, Dr Vivek Tandon, Director of GI Surgery, GI Oncology and Bariatric Surgery, Gastrosciences, Medanta Noida said: "Symptoms such as persistent acidity, upper abdominal discomfort, or recurrent vomiting should not be dismissed as routine gastric issues. Structural abnormalities like paraesophageal hernias can remain undiagnosed for months and may become dangerous if timely intervention is delayed."
Dr Deepak Govil, Director of GI Surgery, GI Oncology and Bariatric Surgery, Gastrosciences, Medanta Noida added: "Robotic surgery offers superior precision, enhanced 3D visualisation, and better maneuverability in anatomically complex spaces. In cases involving dense adhesions and intrathoracic stomach migration, this technology enables safer dissection, reduced postoperative pain, and faster recovery."
Recovery and Outcome
The patient recovered well, resumed oral intake successfully, and was discharged within three days in stable condition.
Importance of Early Diagnosis
The doctors noted that paraesophageal hernias are frequently underdiagnosed because their symptoms closely mimic common acidity or reflux disease. Early imaging including endoscopy and CT scans plays a critical role in identifying these conditions before complications arise.
