V-08. Untwisting the Problem: Robotic-Assisted Management of an Obstructive Gastric Volvulus and Giant Hiatal Hernia

Abstract Topic Benign Disease: Esophageal Surgery Background Gastric volvulus secondary to a giant hiatal hernia is an emergent condition that causes upper gastrointestinal obstruction. Within robotic surgery, it is of great interest to investigate its better visualization and greater range of motion. This video demonstrates the use of the robotic platform in the management of gastric volvulus. Methods A 62-year-old male with a significant medical history of myocardial infarction and a giant hiatal hernia presented to the emergency department with an obstructive syndrome consistent with a gastric volvulus. The CT scan identified a volvulized giant hiatal hernia with a gastric dilation of 15 cm. The robotic surgery protocol was initiated. Once inside the abdominal cavity, the hernia was reduced. Dissection and opening of the gastrohepatic ligament were performed, followed by dissection of the diaphragmatic crura using curved monopolar scissors and a vessel sealer. The articulating capability of the robotic platform allows for optimal visualization of the intrathoracic esophageal hiatus. Once the diaphragmatic crura were repaired, a mesh was placed and secured to the crura with sutures, and a Toupet fundoplication was performed over a nasogastric tube to prevent reflux. Results The robotic platform facilitates intracorporeal movements such as suturing and fine dissection in confined spaces like the esophageal hiatus. The operative time was 77 minutes. There were no complications, and the patient was discharged after a three-day hospital stay without any complications. As a follow-up protocol, an endoscopy was performed, confirming the absence of ischemia or stenosis, as well as the normal positioning and functioning of the Toupet fundoplication. To date, the patient remains completely asymptomatic. Conclusion The robotic approach is an effective minimally invasive option even in emergency cases of gastric volvulus in the setting of a giant hiatal hernia. The articulation capabilities of the robot allow for fine dissection, mesh placement, and suturing in highly restricted spaces. Video Description This video is highly relevant for the congress because it expands the current paradigm of emergency surgical management. While robotic surgery is well-established for elective hiatal hernia repairs, its application in acute, obstructive settings like gastric volvulus remains debated. This case demonstrates that the robotic platform is not only safe in emergencies but highly advantageous. It highlights how enhanced articulation facilitates precise crural dissection, mesh placement, and intracorporeal suturing within a distorted, narrow hiatus. Furthermore, including postoperative endoscopic validation provides objective proof of functional success, proving that complex robotic emergency repairs can achieve fast-track recoveries and excellent outcomes.