Robot-assisted Toupet fundoplication and associated cholecystectomy in symptomatic giant hiatal hernia with situs viscerum inversus-A case report and literature review

Int J Surg Case Rep. 2019;60:371-375. doi: 10.1016/j.ijscr.2019.06.038. Epub 2019 Jun 22.


Introduction: Giant hiatus hernia is defined as migration of >30% of the stomach with or without other intra-abdominal organs into the chest. Situs Viscerum Inversus is a rare congenital condition in which the major visceral organs are reversed from their normal arrangement; they are translated (completely or partially) on the opposite side of the body. Diagnosis is often incidental. We report a Robot-assisted Toupet fundoplication for a giant hiatal hernia with gastro oesophageal reflux disease and cholelithiasis, in a 63-years-old woman with situs viscerum inversus.

Presentation of case: A 63-year-old woman with Situs Viscerum Inversus was diagnosed with giant sliding hiatus hernia. We performed a Robot-assisted procedure of reduction of hiatal hernia in abdomen and Toupet fundoplication with Bio A mesh placement and gastropexy procedure associated to cholecystectomy. The operation time was of 190min. The patient was discharged on third postoperative day after X-ray check and he tolerated a solid food.

Discussion: Minimally invasive surgery represents, nowadays, the standard approach for hiatal hernia and cholelithiasis.

Conclusion: In challenging cases as the giant hernias ad rare anomaly as situs viscerum inversus, the surgical treatment can be facilitated by the use of robotic technology.

Keywords: Cholecystectomy-case report; Gastro oesophageal reflux disease; Giant hiatal hernia; Mesh placement; Robotic surgery; Situs Viscerum Inversus; Toupet fundoplication.