Incarcerated paraesophageal hernia and gastric volvulus: Management options for the acute care surgeon, an Eastern Association for the Surgery of Trauma master class video presentation

Acute PEH and GVoften require urgent surgery. Being familiar with the presenting signs and symptoms can lead to a quick and accurate diagnosis which is critical to timely intervention. If strangulation, volvulus, obstruction, bleeding, or perforation is present, emergent operative intervention is indicated. Appropriate resuscitation should be performed with balanced crystalloid and/or blood along with correction of any electrolyte derangements. Broad-spectrum antibiotics should be initiated, with NGT decompression and urgent surgical repair. Surgeon experience and patient physiology will drive surgical approach regarding open transabdominal or laparoscopic. The key principles of a safe operation are to control sepsis by PEH reduction and derotation of GV tension free repair: immediate or in a delayed fashion. The sequence for the operation is the same regardless of approach and follows patient physiology: dissection of the hiatus and reduction of the hernia sac, derotation of the stomach if GV is present, mobilization of intrathoracic esophagus, tension-free repair of the crura/hiatal defect with fundoplication, and possible gastropexy.