Robotic Redo Paraesophageal Hernia Repair Following a Nissen Fundoplication

The patient was a 68-year-old male with a history of type 3 paraesophageal hernia (PEH) recurrence post receiving a Nissen fundoplication and an attempted robotic repair one year prior. The repair was aborted intraoperatively due to respiratory decline and hypercapnia. His past medical history was also notable for Cameron's ulcers, chronic obstructive pulmonary disease (COPD), gastroparesis, gastroesophageal reflux disease (GERD), hypertension (HTN), obesity, and obstructive sleep apnea (OSA). The patient underwent a repeat preoperative work-up, which included a CT scan of the abdomen and pelvis, upper gastrointestinal X-ray with LINX, an esophagogastroduodenoscopy (EGD), and a transthoracic echocardiogram (TTE). Due to the complexity of the case and the requirement for both abdominal and thoracic entry, both general and thoracic surgery teams participated in the procedure. The postoperative course was significant for bilateral parietal watershed infarcts, which required ICU admission. The patient was discharged on postoperative day 11 to an inpatient rehabilitation facility, at which time he tolerated an oral diet. 

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