Abstract
Giant hiatal hernias (GHHs), defined as herniation of >30% to 50 % of the stomach into the thorax, are a type of paraesophageal hernia (Type III or IV) that can cause significant extraesophageal symptoms, including progressive dyspnea and cardiac compromise, due to mechanical compression of thoracic organs. We report the case of a 60-year-old female patient (weight 57 kg, height 161, BMI 22) who presented with severe, refractory gastroesophageal reflux disease (GERD) and progressive dyspnea on exertion. Diagnostic imaging (CT scan) confirmed a large, giant Type III/IV hiatal hernia containing most of the stomach, causing compression of the left lower lobe of the lung. The patient underwent successful laparoscopic repair of the GHH, which included complete sac excision, extensive mediastinal esophageal mobilization, tension-free crural repair using absorbable barbed suture, and a standard Nissen fundoplication. The postoperative course was uneventful. The patient reported immediate and complete resolution of dyspnea and improvement in GERD symptoms. Follow-up at 6 months confirmed no recurrence on barium swallow and a significantly improved quality of life. Laparoscopic repair with Nissen fundoplication is the standard of care and an effective definitive treatment for GHHs, providing dramatic symptomatic relief, particularly for patients presenting with atypical pulmonary symptoms like dyspnea.