Laparoscopic Management of Totally Intra-thoracic Stomach with Collis–Nissen Gastroplasty for Short Esophagus

Intra-thoracic gastric volvulus, a rare form of giant hiatal hernia, involves the migration of the stomach into the chest cavity through rotation along its longitudinal or transverse axis and can lead to severe complications. Laparoscopic repair of this condition is the most technically challenging among benign foregut surgeries. Key steps include total excision of the hernia sac, ensuring adequate length of the esophagus through full mobilization, performing a tensionless hiatoplasty, and creating a floppy fundoplication. The length of the intra-abdominal esophagus is measured to determine whether to perform a standard anti-reflux procedure or lengthen the esophagus. If the esophagus is irreversibly short ("true short esophagus"), the short gastric vessels are divided, and the gastric fundus is mobilized. An endostapler is then used to resect a wedge of the gastric fundus to elongate the esophagus, followed by a Collis gastroplasty over a 46 Maloney bougie, and completion of the procedure with a floppy Nissen fundoplication and hiatoplasty.