Giant hiatus hernia: closure of the difficult hiatus

Abstract

Repair of the large hiatus hernia has been troubled by diaphragmatic hiatal repair failure and recurrence. Use of mesh repair may reduce recurrence at a cost of increased reoperative complications and mesh fistulation. Methods of hiatal closure facilitation are described. Techniques and accompanying intra-surgery pictures are discussed here based on personal experience from within a service performing variable 100 giant hernia repairs annually. Techniques for closure of a large hiatus without mesh repair are described with illustration, the purpose to expose various techniques utilized in a service performing more than 100 giant hernia repairs annually. Techniques adopted and described in this article may facilitate both mesh and non-mesh repair of crural hiatal defects associated with giant hiatus hernia.