A rare case of complicated hernioplasty and reconstruction of the gastroesophageal junction: multistage treatment with a positive outcome

Abstract

This clinical case presents the complex and multistage management of a 48-year-old woman with a recurrent hiatal hernia following previous laparoscopic surgical treatment. The initial surgery was complicated by technical errors, leading to early recurrence of the hernia. Subsequent laparoscopic reintervention included mesh-reinforced hernioplasty and revision fundoplication. However, the postoperative course was complicated by the development of acute gastric fundus ischemia and necrosis, which necessitated urgent atypical wedge resection of the stomach. Despite initial recovery, the patient later developed further complications, including a mesh-related gastric ulceration and the formation of a chronic inflammatory infiltrate in the upper abdominal cavity. These adverse events required a relaparotomy, complete mesh removal, proximal gastrectomy, and complex gastrointestinal reconstruction using the double-tract method. The management of this case illustrates several critical challenges: the risk of ischemic complications following fundoplication, the long-term sequelae of mesh implantation at the gastroesophageal junction, and the technical considerations necessary for successful reconstruction after proximal gastrectomy. Special attention was paid to minimizing postoperative reflux, preserving nutritional function, and ensuring a high quality of life. This clinical case highlights the importance of careful patient selection, meticulous surgical technique, and the necessity for early recognition and management of postoperative complications. Through a stepwise, multidisciplinary surgical approach, a positive long-term outcome was achieved, with the patient demonstrating good tolerance to a regular diet, no signs of reflux, and satisfactory functional recovery.