Motion picture

Aim: To relieve symptoms of left upper quadrant pain and vomiting in a 70-year-old woman diagnosed with a type III paraesophageal hiatal hernia and suspected incomplete gastric volvulus, a laparoscopic hiatal hernia repair, fundoplication, and PEG insertion were performed.Methods: Following an urgent OGD examination, a feeding tube was inserted for nutritional support.Three weeks later, she underwent laparoscopic repair of the hiatal hernia, Dor's anterior partial fundoplication, and PEG insertion.Results: The operation lasted 3 h and 6 min, with a blood loss of 100 mL.She was discharged 1 week post-operation, having tolerated PEG and oral feeding.As of May 2025, 6 months post-op, she primarily consumes oral food with occasional PEG supplements.Her epigastric pain has resolved, and she has gained weight.Literature suggests elective hiatal hernia repair is beneficial for asymptomatic or minimally affected patients, even in advanced age with comorbidities, as the risks of disease progression outweigh surgical risks.Mesh repair does not significantly reduce recurrence and may lead to dysphagia or mesh erosion requiring further surgery.While there is no direct comparison of suture gastropexy and PEG fixation for recurrence reduction, our experience indicates that PEG can support patients transitioning to oral intake. Conclusion:Hiatal hernia can cause severe upper abdominal pain and vomiting, compromising nutrition.A laparoscopic repair, Dor's fundoplication, and PEG insertion can restore anatomy, minimize hospital stay, and enable gradual resumption of oral intake.