Robotic Redo Paraesophageal Hernia Repair Following a Nissen Fundoplication

Thank you for your response. Nine months prior to this operation, the patient had a MICU admission for hemorrhagic shock secondary to their large type III hiatal hernia and Cameron ulcers. At that time, repair was attempted, however, the case was aborted after the stomach was reduced and pexied to the abdominal wall without definitive repair of the defect due to respiratory decline. Following that admission, the patient experienced persistent GERD and intense abdominal pain refractory to medical management. He remained anemic with Hg 9-10. The patient was advised that he was at high risk for surgery given his history of intra-op respiratory decline & hypercapnia. He expressed a strong desire for surgery. The case took approximately 11 hours. The gastrostomy tube served as an additional way to pexy the stomach to the abdominal wall. The G-tube was removed post-op, as the patient was able to tolerate sufficient PO intake. He is now in rehab without symptoms, able to tolerate solids without dysphagia, regurgitation, nausea, or vomiting. He has had no further hospital admissions and no evidence of recurrence post-op. This patient’s case highlights the complexity of surgical decision-making in high-risk individuals. Despite significant risks, the patient was motivated to pursue definitive repair to improve his quality of life, and his recovery reflects the success of a multidisciplinary approach to his care. While his stroke was a serious complication, his subsequent rehabilitation and symptom-free state underscore his resilience and the long-term benefits of resolving his paraesophageal hernia. Moving forward, a continued focus on rehabilitation and close follow-up will be crucial to ensure sustained improvement in his quality of life and to monitor for any late complications.