A
hiatal hernia describes a defect of the portion of the esophageal hiatus of the diaphragm, which leads to herniation of the abdominal contents into the chest cavity. Type IV
paraesophageal hernias (PEH) have been associated with relatively large defects and are usually symptomatic. Surgical intervention is indicated in patients with symptoms or complicated
paraesophageal hernias. The elderly age group represents a challenge in terms of management approach. Our purpose is to emphasize the safety and efficacy of early laparoscopic posterior cruroplasty and anterior
gastropexy during PEH repair in the elderly age group. A 90-year-old male without significant past medical or surgical history was admitted for a five-day history of left upper quadrant
abdominal pain associated with multiple episodes of
vomiting. The physical exam revealed left upper quadrant
pain and rebound tenderness. Abdominal CT with IV contrast showed a large
hiatal hernia containing the entire stomach and part of the duodenum with an abrupt transition zone at the duodenum. The patient underwent laparoscopic
hiatal hernia repair, posterior cruroplasty, and anterior
gastropexy. Postoperatively, the patient tolerated the procedure, and further follow-up in the clinic showed resolution of his symptoms without complications. Prompt identification and proper management represent a crucial step in the management of PEH, especially in elderly comorbid patients. Laparoscopic anterior
gastropexy is a safe and effective method for type III/IV
hiatal hernias in elderly patients.