Laparoscopic Distal Gastrectomy for Gastric Cancer Associated with a Paraesophageal hiatal hernia (PEH) Containing the Small Intestine in an Elderly Patient

An 82-year-old man was diagnosed with gastric cancer in the antrum complicated by a large type IV PEH containing the small intestine. Preoperative imaging demonstrated herniation of the small intestine into the mediastinum through a markedly dilated esophageal hiatus. A totally laparoscopic distal gastrectomy with lymphadenectomy and simultaneous hiatal repair was performed. After gentle reduction of the herniated small intestine, the diaphragmatic crura were closed with primary sutures without mesh reinforcement or fundoplication. The postoperative course was uneventful, and the patient was discharged without major complications.