Abstract
Intrathoracic stomach represents herniation of greater than 75 % of the stomach through the esophageal hiatus into the thoracic cavity. The most common symptoms include intermittent dysphagia for solids, abdominal and chest pain secondary to visceral torsion, gastrointestinal bleeding from mucosal ischemia resulting in iron deficiency anemia, and heartburn. A high incidence of acute volvulus with possible gangrene, perforation, or hemorrhage requiring emergent surgery has been reported, and elective repair has been recommended [1] though not universally accepted for asymptomatic patients. All symptomatic PEH should be repaired especially if they have symptoms suggesting incarceration. The operative repair was traditionally via left thoracotomy and subsequently via laparotomy though laparoscopic repair is feasible in nearly all patients. Cuscheri first reported laparoscopic repair of paraesophageal hernia in 1992 [2]. Operative strategy includes sac and hernia reduction with hiatus closure along with or without fundoplication.