Abstract
The repair of large hiatal hernias has always been problematic as can be difficult to perform and plagued with a high recurrence rate. The most common cause of recurrent hernias after initial successful surgery is failure of the crural closure. Numerous techniques have been employed to mitigate this problem including mesh implantation to reinforce the diaphragmatic closure and diaphragmatic relaxing incisions to minimize tension on the repair. This chapter discusses some of the more popular techniques with a focus on the impact of mesh at the hiatus. We discuss the current controversies and alternatives concerning the use of meshes in hiatal hernia repair.
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