A rare case of neurogenic belching caused by surgical tacks

Abstract

Gastric belching is a normal physiologic process whereby air travels in a retrograde fashion from the stomach out the mouth, whereas supragastric belching is considered to be behavioral and occurs when swallowed air originating in the esophagus exits the mouth. After hiatal hernia repair, patients commonly report an inability to belch. However, a drastic increase in belching after hiatal hernia repair is highly unusual. We present a rare case of surgically induced, pseudo-supragastric belching caused by phrenic nerve irritation from surgical tacks placed during hiatal hernia repair. The patient’s symptoms resolved completely after the tacks were removed during the repeat operation. Surgeons should pay careful attention to the diaphragmatic and phrenic nerve anatomy and must take extreme care during mesh fixation to the hiatus during foregut surgery.