A Rare Coexistence of Gastric Fundal False Diverticulum and Sliding Hiatal Hernia: Technical Considerations and Literature Review

Gastric fundal false diverticula are exceedingly rare, and to our knowledge, this is the first reported case occurring in association with a sliding hiatal hernia. We describe a 49-year-old woman who presented with persistent dysphagia, regurgitation, heartburn, and halitosis refractory to medical therapy. Imaging revealed a 5.0 × 3.6 × 4.7 cm false diverticulum at the posteromedial fundus and a sliding hiatal hernia. Esophageal manometry demonstrated normal motility with ineffective bolus clearance. Laparoscopic management was employed, combining intraoperative endoscopy for diverticulum localization and staple-line verification with laparoscopic dissection and repair. The procedure included diverticulum excision with an endoscopic stapler, posterior crural closure reinforced with pledgeted sutures, and anterior partial fundoplication. Histopathology confirmed a false diverticulum with complete absence of the muscularis propria layer and no malignancy. At the 1-year follow-up, the patient reported significant symptom resolution. This case highlights the laparoscopic management in complex gastric diverticula and provides a valuable surgical option for similar cases.