Large Hiatal Hernia Research Articles

S2874 It's Not Always in the Skin: Diagnosing Systemic Sclerosis Sine Scleroderma in a Patient With a Large Hiatal Hernia

S2874 It's Not Always in the Skin: Diagnosing Systemic Sclerosis Sine Scleroderma in a Patient With a Large Hiatal Hernia

Gastroesophageal reflux after Roux-en-Y gastric bypass: Is it just related to technical details?

Although it is uncommon, gastroesophageal reflux disease can present after Roux-en-Y gastric bypass, and it is usually related to technical errors. Hiatal hernia, a narrow calibrated gastrojejunostomy and a long gastric pouch are all factors associated with the development of pathologic gastroesophageal reflux. Techniques are available to treat this condition, such as fundoplications with the gastric remnant, gastropexy to the arcuate ligament, teres ligament repair, or sphincter augmentation with the LINX device.Despite the growing number of reports of gastroesophageal reflux after Roux-en-Y gastric bypass, it should be still considered the best surgical option for patients with obesity and a large hiatal hernia or complications secondary to gastroesophageal reflux disease.

Reflujo tras bypass gástrico. ¿Solo depende de aspectos técnicos?

Although it is uncommon, gastroesophageal reflux disease can present after Roux-en-Y gastric bypass, and it is usually related to technical errors. Hiatal hernia, a narrow calibrated gastrojejunostomy and a long gastric pouch are all factors associated with the development of pathologic gastroesophageal reflux. Techniques are available to treat this condition, such as fundoplications with the gastric remnant, gastropexy to the arcuate ligament, teres ligament repair, or sphincter augmentation with the LINX device.Despite the growing number of reports of gastroesophageal reflux after Roux-en-Y gastric bypass, it should be still considered the best surgical option for patients with obesity and a large hiatal hernia or complications secondary to gastroesophageal reflux disease.

Large incidental hiatal hernia in a patient with colorectal cancer: the upside-down stomach

Large incidental hiatal hernia in a patient with colorectal cancer: the upside-down stomach

Surgical Repair of Large Hiatal Hernias: Insight from a High-Volume Center

BackgroundLaparoscopic-assisted hiatal hernia (HH) repair is safe and effective; however, it is unclear whether hernia size affects perioperative outcomes and whether a watch-and-wait strategy is appropriate for patients with asymptomatic large HHs. We aimed to investigate these issues. MethodsAfter IRB approval, we queried our prospectively maintained database for patients who underwent primary laparoscopic HH repair at our center between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). According to the intraoperative findings, HHs were divided into four groups: small (S-HH), medium (M-HH), large (L-HH), or giant (G-HH) when the percentage of herniated stomach was 0% (sliding), < 50%, 50–75%, or > 75%, respectively. Perioperative and mid-term outcomes were analyzed. ResultsA total of 170 patients were grouped: S-HH (n = 46), M-HH (n = 69), L-HH (n = 20), and G-HH (n = 35) with mean age of 58.5.6 ± 11.0, 61.9 ± 11.3, 70.7 ± 10.3, and 72.6±9.7 years (p < 0.001), respectively. Compared to M-HH patients, L-HH patients had significantly longer hospital stays (mean 2.8±3.2 vs 1.4±0.91 days; p = 0.001) and more postoperative complications (6/20 [30.0%] vs 3/69 [4.3%]; OR 6.9, 95% CI 5.4–8.4, p < 0.001). At a mean follow-up time of 43.1±25.0 and 43.5±21.6 months for the combined S/M-HH and L/G-HH groups, GERD-Health-Related Quality of Life scores were comparable (S/M-HH: 6.5±10.9 vs L/G-HH: 7.1 ± 11.3; p = 0.63). There was no perioperative mortality. ConclusionsHHs likely grow with age, reflecting their progressive nature. Laparoscopic L-HH repair was associated with higher morbidity than M-HH repair. Thus, patients with M-HH, even if less symptomatic, should be evaluated by a foregut surgeon. Regardless of HH size, good mid- and long-term quality of life outcomes can be achieved.

480. ANTIREFLUX SURGERY’S LIFESPAN: 20 YEARS AFTER LAPAROSCOPIC FUNDOPLICATION

Abstract Background Laparoscopic Fundoplication (LF) is the surgical technique of choice for treating GERD, but only few studies report a follow-up beyond 15 years. The aim was to evaluate the results at least 20 years after laparoscopic fundoplication at a single national referral center for esophageal diseases. Methods We prospectively collected data on a cohort of consecutive patients who underwent LF between 1992–2001. Patients were divided into two groups: a GERD group (patients with pathological esophageal acid exposure and hiatal hernias &amp;lt;3 cm) and a large hiatal hernia (HH) group (patients having type I &amp;gt; 3 cm and types II-IV hiatal hernias). Patients were followed up for at least 20 years using endoscopy, barium-swallow, esophageal manometry, and pH monitoring. LF was defined failed in case of: GERD symptom recurrence (SS &amp;gt; 10); recurrence of esophagitis; HH recurrence or slipped-fundoplication; pathological pH-monitoring; BE progression or adenocarcinoma onset. Results The study population consisted of 142 patients: 112 in the GERD group and 30 in the HH group. The characteristics of patients are shown on Figure 1. Conversion to open surgery proved necessary in 8 patients (5.6%). At a median follow-up of 22 years, 80.4% of the GERD patients and 63.3% of the HH patients were failure-free. Revisional surgery was necessary in 14 (9.8%) patients (9 GERD and 5 HH patients); indications were dysphagia (5 cases), slipped fundoplication or hernia recurrence (6 cases), abnormal pH-monitoring or esophagitis resistant to medical therapy (2 cases), and telescoping (one case). Two decades after LARS, 87.6% of GERD patients and 76.7% of HH patients were satisfied with the procedure. Conclusions The present study concerns one of the largest populations of patients who had undergone LF to have been followed up for more than 20 years at a single center. The findings showed that laparoscopic antireflux surgery is effective and durable (for &amp;gt;20 years) in patients with uncomplicated GERD and, to a lesser extent, in those with a large hiatal hernia. The satisfaction rate more than 20 years after surgery almost reached 90% in the GERD group.

210. BIORESORBABLE SYNTHETIC MESHES IN LARGE PARAESOPHAGEAL HERNIAS. TECHNIQUE OF APLICATION AND EARLY RESULTS

Abstract Background Large paraesophageal hernias (LPEH) are still a challenge faced by foregut surgeons. Surgical options are highly debated among specialists; esophageal lengthening procedures, diaphragmatic relaxing incisions, gastropexy and—mesh reinforcement. Severe complications related to synthetic meshes has led many surgeons to avoid this type of reinforcement. However, newly developed synthetic bioresorbable meshes have been used as an alternative for hiatal reinforcement, lowering the rates of recurrence without the drawbacks of synthetic materials. Methods From April 2018 to February 2023, 65 patients underwent LPEH repair with hiatal augmentation with an inverted C-shape bioresorbable mesh. All surgeries were performed by two surgeons (AB and NCA). The meshes (Bio-A®—Gore® and Phasix ST®—BARD) were applied over crurorrhaphy, covering the anterior and posterior aspects of the hiatus and secured in place with sutures and cyanoacrylate. The choice of mesh was determined by the surgeon’s preference. Follow up visits were at 1, 6 and 12 months and yearly after that. Results There were 34 patients where Bio-A was used and 31 with Phasix. Median age (55,5 vs 54,8 years) didn’t differ between groups. LPEH were primary (PS) in 39 patients and recurrence from prior interventions (RS) in 26. Median age was higher in PS (58,6 vs 49,6 years). There were no intraoperative complications related to the use of mesh. The patients were discharged after 24–48 hours. The average follow-up period was similar between PS and RS (10,1 vs 9,6 months). There were three recurrences (2 Bio-A, 1 Phasix) in PS (7,6%) and seven (26,9%) in RS (2 Bio-A, 5 Phasix). There weren’t complaints of prolonged dysphagia or need for dilatation. Nine out of 10 recurrences are small. One large recurrence, required reintervention for acute volvulus after 1 year (RS group with Phasix). Conclusion bioresorbable meshes are safe to use as a reinforcement of hiatoplasty in LPEH. They can reduce recurrence and reoperation rates in PS at a short term follow-up. Large recurrent hiatal hernias still present as a major challenge and adjuvant techniques should be employed to further reduce recurrences.

439. ACUTE GASTRIC VOLVULUS—LATE OCCURRENCE AFTER HIATAL HERNIA REPAIR WITH MESH

Abstract Video presentation of acute gastric volvulus in one patient with previous history of a giant recurrent hiatal hernia, corrected with synthetic absorbable mesh one year prior to the event. The video contains the first surgery, follow-up studies, the intra operative findings (mesh status) and resolution. It raises the question whether, in extremely large hiatal hernias, specially recurred ones, adjuvant techniques should be associated. https://www.dropbox.com/s/tkj2vt35cd3pn91/Acute%20Gastric%20Volvulus.mov?dl=0.

181 Lessons Learned from Complex Abdominal Wall Reconstruction for the Management of Giant Paraoesophageal Hernia - a Case Analysis

Abstract Aim In this case report, we present a new method in the management of a giant hiatus hernia: the use of crural relaxing incisions. This new method in combination with previously known strategies including botox and preoperative optimisation for surgery with weight loss and prehabiliation can result in a more effective surgical hiatus hernia repair and subsequently lead to a reduced risk of hiatus hernia recurrence. Case Presentation 71yo man admitted to hospital with a one-week history of generalised abdominal pain, nausea, vomiting and chest pain. He had a background of a known large hiatus hernia for the last 10 years. An abdominal CT showed a large type IV hiatus hernia containing the stomach, transverse colon, pancreatic body, and pancreatic neck. CT guided botulinum toxin A injections were given by interventional radiology during which the muscle bellies of the transversus abdominus, internal and external obliques were targeted. The patient was placed on a meal replacement (Optifast) diet. A laparoscopic thoraco-abdominal hiatus repair was performed finding a giant hiatus hernia containing the entire stomach, first part of the duodenum, left lobe of liver, transverse colon, small bowel and distal pancreas. Due to the size of the hiatus hernia and the potential tension likely to result from a repair, both right and left crural relaxing incisions were made to facilitate closure. Crural closure was reinforced with a Bio A mesh secured in a C configuration covering the right crural relaxing incision. The patient recovered well postoperatively. Follow up imaging did now show recurrence.

Role of Mesh in the Reinforcement of the Primary Repair of Large Hiatal Hernia

Abstract Background The incidence of hiatal hernias increases with age. Approximately 55%-60% of individuals over the age of 50 have a hiatal hernia. However, only about 9% have symptoms, and it depends on the type and competency of the lower esophageal sphincter. Aim of the Work In our study, an objective observational study was made regarding post operative short term mesh related complications possible to develop in patients underwent hiatal repair of large hiatal hernia with mesh rienforcement. Patients and Methods An observational cohort (retrospective and prospective) study regarding the post operative mesh related complications in patients who underwent Large diaphragmatic hernia repair with mesh application. The study was conducted at Ain Shams University Hospitals, Al-Demerdash, Department of General surgery. Approval of the research ethics Committee of medicine and general surgery department at faculty of medicine, Ain Shams University as well as a written informed consent from all participants was obtained. The study was conducted on 15 patients over a period of six months, starting from date of approval of the protocol by the faculty and the university committee at 10/7/2021. Results Five patients (33.3%) complained about dysphagia postoperatively. In one case, the symptoms declined spontaneously within 6 months was grade 1. Another patient successfully underwent esophageal dilatation of a stenosis 2 months postoperatively was grade 2. Up to this date, two patients (13.3%) still report mild dysphagia but maintain normal body weight were grade 3. Three cases report persistent intraabdominal discomfort without weight loss described as bloating. Two patients experienced heartburn, while another patient reported respiratory compromise in the form dyspnea due to already huge hiatal defect with lung collapse present preoperatively. Conclusion Laparoscopic large hiatal/paraesophageal hernia repair with prosthetic meshes as well as laparoscopic antireflux surgery with prosthetic hiatal closure are safe and effective procedures to prevent hiatal hernia recurrence and/or postoperative intrathoracic wrap migration, with low complication rates and mesh fixation is indicated in patients with large hiatal hernial defect &amp;gt; 5 cm.

5-Year Collis-Nissen Gastroplasty Outcomes for Type III-IV Hiatal Hernia with Short Esophagus: A Prospective Observational Study.

To assess the 5-year outcomes of patients undergoing Collis-Nissen gastroplasty for type III-IV hiatal hernia with short esophagus. From a prospective observational cohort of patients who underwent antireflux surgery for type III-IV hiatal hernia between 2009 and 2020, those with short esophagus (abdominal length <2.5 cm) in whom a Collis-Nissen procedure was performed and reached at least 5 years of follow-up were identified. Hernia recurrence, patients' symptoms, and quality of life were assessed annually by barium meal x-ray, upper endoscopy, and validated symptoms and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires. Of the 114 patients with Collis-Nissen gastroplasty, 80 patients who completed a 5-year follow-up were included (mean age 71 years). There were no postoperative leaks or deaths. Recurrent hiatal hernia (any size) was identified in 7 patients (8.8%). Heartburn, regurgitation, chest pain, and cough were significantly improved at each follow-up interval (p < 0.05). Preoperative dysphagia disappeared or improved in 26 of 30 patients, while new-onset dysphagia occurred in 6. Mean postoperative QOLRAD scores significantly improved at all dimensions (p < 0.05). Collis gastroplasty combined with Nissen fundoplication provides low hernia recurrence, good control of symptoms, and improved quality of life in patients with large hiatal hernia and short esophagus.

Mesh-Enforced Repair and Anterior Fundoplication in Large Hiatal Hernias: Few Side-Effects and a High Patient Satisfaction – The Best Way to Go?

Abstract Background Nissen and Toupet fundoplication are the predominant procedures in the treatment of large hiatal hernias. Nevertheless, these techniques may cause relevant side-effects such as increased bloating or dysphagia, thus impairing the patient's quality of life. Aims To evaluate the mid-term outcome after mesh-enforced hiatoplasty and anterior fundoplication in large hiatal hernia repair. Methods Prospective single-center study investigating the clinical, endoscopic and radiological outcome after laparoscopic, mesh-enforced hiatoplasty and anterior fundoplication in patients with large hiatal hernias. Results Ninety-nine patients were operated between 2012–2022 and met all the inclusion criteria including postoperative computed tomography (CT). 68% were female, mean age was 71 ± 10 years, 72% of the patients needed proton pump inhibitors (PPI) prior to surgery. In all patients, more than 20% of the stomach was located supra diaphragmatic, in 65% more than 50% of the stomach was herniated. Mean operation time was 152 ± 45 minutes, there were no major intraoperative complications and one short-term postoperative complication demanding operative revision due to early recurrence. Mean length of stay was 5.1 ± 1.9 days. Upper endoscopy was performed in 94% after 16 weeks and showed a correct position in all cases. Clinical and CT follow-up were obtained in all patients after 1.6 ± 1 years. 87% had a correct position of the fundoplication in CT, 6% had a slippage and 7% a recurrent hernia. Two patients needed operative revision. 84% of patients reported their clinical outcome as excellent, 10% as good. Mean Gastrointestinal Qualitiy of Life Index was 126 ± 14. 98% of patients would perform the surgery again. Conclusions Mesh-enforced hiatoplasty and anterior fundoplication in large hiatal hernia repair is safe and leads to a high rate of patient satisfaction. The radiological outcome poorly correlates with clinical symptoms or patient reported outcome.

Transoral incisionless fundoplication and open hiatal hernia repair: A case report

IntroductionTransoral incisionless fundoplication is a new procedure that has recently emerged as a potential alternative to traditional anti-reflux surgeries. It is a less invasive option with fewer complications and reduced recovery time. Hiatal hernia repair is also commonly performed in conjunction with transoral incisionless fundoplication to improve outcomes. In this case, it details a successful transoral incisionless fundoplication and hiatal hernia repair procedure in a patient with long standing gastroesophageal reflux disease (GERD). The case is unique as it involved a patient with an uncharacteristically large hiatal hernia measuring above 5cm, which is a size that is generally not considered suitable for transoral incisionless fundoplication. The hiatal hernia was repaired with a gastrectomy instead of laparoscopically due to the size and adhesions present.Case detailsThis case report presents an 86 year old female patient with a history of long-standing GERD symptoms from the past 10 years who had failed to respond to medical therapy. Endoscopic imaging revealed a hernia of more than 5cm in size, which was confirmed by a bravo study. A DeMeester score of 446 was reported. The patient was referred for surgery and underwent transoral incisionless fundoplication with hiatal hernia repair. Despite the large size of the hiatal hernia, it was decided to proceed with a transoral incisionless fundoplication (TIF) procedure combined with hiatal hernia repair. The gastrectomy was chosen due to significant adhesions and anatomical distortion, making it difficult to continue laparoscopically. The esophagus was fibrosed to the pericardium, and the stomach was stuck in a retrocardiac position. Laparoscopic removal of the adhesions proved difficult since the patient had friable tissues, and there was a high risk of injury to surrounding organs. The surgery was therefore converted to an open approach, and the hernia was repaired with a gastrectomy. The TIF procedure was performed successfully, and the patient had no complications postoperatively.ConclusionThis case details a successful transoral incisionless fundoplication procedure for GERD in a patient with an uncharacteristically large hiatal hernia. Despite the challenges posed by the hernia’s size and anatomical distortion, the TIF procedure combined with hiatal hernia repair was successful in providing relief from GERD symptoms, with no postoperative complications. The case highlights the potential suitability of TIF as an alternative to laparoscopic fundoplication in patients with large hiatal hernias, although gastrectomy may be necessary in cases with significant adhesions or anatomical distortion.

Anterior reconstruction of the esophageal hiatus: a novel approach for the repair of large diaphragmatic hernias

Introduction: Paraesophageal hernias (PEH) often require surgical repair. The standard approach, primary posterior hiatal repair, has been associated with a high recurrence rate. Over the past few years, we have developed a new approach for repairing these hernias, which we believe restores the original anatomy and physiology of the esophageal hiatus. Our technique includes anterior crural reconstruction with routine anterior mesh reinforcement and fundoplication. Objective: To determine the safety and the clinical success of anterior crural reconstruction with routine mesh reinforcement. Material and methods: Data were collected retrospectively on 178 consecutive patients who had a laparoscopic repair of a symptomatic primary or recurrent PEH between 2011 and 2021 using the above technique. The primary outcome was clinical success, and the secondary outcome was 30 days of major complications and patient satisfaction. This was assessed by imaging tests, gastroscopies, and clinical follow-up. Results: Mean follow-up was 65 (SD 37.1) months. No intraoperative or 30 days postoperative mortality or major complications were recorded. Recurrence rate requiring a re-operation was 8.4% (15/178). Radiological and gastroenterological evidence of minor type 1 recurrence was 8.9%. Conclusion: This novel technique is safe with satisfactory long-term results. The outcome of our study will hopefully motivate future randomized control trials.

Research protocol for the Paraesophageal hernia symptom tool, a prospective multi-center cohort study to identify the need and threshold for surgery and assess the symptom response to surgery.

Large hiatus hernias with a significant paraesophageal component (types II-IV) have a range of insidious symptoms. Management of symptomatic hernias includes conservative treatment or surgery. Currently, there is no paraesophageal hernia disease-specific symptom questionnaire. As a result, many clinicians rely on the health-related quality of life questionnaires designed for gastro-esophageal reflux disease (GORD) to assess patients with hiatal hernias pre- and postoperatively. In view of this, a paraesophageal hernia symptom tool (POST) was designed. This POST questionnaire now requires validation and assessment of clinical utility. Twenty-one international sites will recruit patients with paraesophageal hernias to complete a series of questionnaires over a five-year period. There will be two cohorts of patients-patients with paraesophageal hernias undergoing surgery and patients managed conservatively. Patients are required to complete a validated GORD-HRQL, POST questionnaire, and satisfaction questionnaire preoperatively. Surgical cohorts will also complete questionnaires postoperatively at 4-6weeks, 6months, 12months, and then annually for a total of 5years. Conservatively managed patients will repeat questionnaires at 1year. The first set of results will be released after 1 year with complete data published after a 5-year follow-up. The main results of the study will be patient's acceptance of the POST tool, clinical utility of the tool, assessment of the threshold for surgery, and patient symptom response to surgery. The study will validate the POST questionnaire and identify the relevance of the questionnaire in routine management of paraesophageal hernias.

V-029 TRANSABDOMINAL LAPAROSCOPIC MANAGEMENT OF RECURRENT LUMBAR HERNIA (GRYNFELT)

Abstract Aims Lumbar hernias are very rare defects of the posterior abdominal wall.They can be classified as Grynfelt in the upper lumbar space(it is the most frequent) and Petit in the lower lumbar triangle. Its treatment can be performed by open approach, or by laparoscopic approach(TAPP or TEP), observing a lower incidence of recurrences and postoperative pain by laparoscopy. Methods Video-case. Results 78-year-old female who attended the clinic presenting a lump that had been increasing in size and was causing pain in the left upper lumbar region. Surgical histories: open lumbar hernioplasty(2018). Physical examination: recurrent left-lumbar hernia(Grynfelt).CT-scan: left-lumbar hernia(defect:45mm) with colon into the hernial sac and a large paraesophageal hiatal hernia. Since the hiatal hernia also needs to be treated, we decided to perform a laparoscopic TAPP-approach to treat the lumbar hernia.The patient was placed in the right lateral decubitus. We use 3 ports(1×12mm,2×5mm) to perform the surgery and place a 10×15cm PVDF mesh fixed with Tisseel and closed the peritoneum with V-Lock 3-0.The patient presented a satisfactory evolution without complications and was discharged in 1°POD. No recurrence. Conclusion Lumbar hernias are a disease with a very low incidence, so there is no clear consensus on the best surgical treatment.Our group think the laparoscopic approach in this type of hernia, whether through the transabdominal(TAPP) or extraperitoneal(TEP) approach, is the most appropriate, since it offers the advantages of minimally invasive surgery(less postoperative pain, shorter LOS) and &amp;lt;postoperative complications related to the surgical site and a lower incidence of hernia recurrence have been reported.

Laparoscopic large hiatus hernia repair with mesh reinforcement versus suture cruroplasty alone: a systematic review and meta-analysis.

To compare the difference in outcomes in laparoscopic large hiatus hernia (LHH) repair using suture-based and mesh-based repair techniques. A systematic search of articles was conducted in PubMed, Medline and Embase using the PRISMA guidelines. Studies comparing recurrences and reoperations in those patients with large hiatal hernia repair (> 30% stomach in the chest, > 5cm hiatal defect, hiatal surface area > 10 cm2) who had mesh vs no mesh were assessed quantitatively. The impact of mesh on significant intraoperative/postoperative surgical complications was qualitatively assessed. Pooled data included six randomized controlled trials and thirteen observational studies with 1670 patients (824 with no mesh, 846 with mesh). There was a significant reduction in the total recurrence rate with mesh (OR 0.44, 95% CI 0.25-0.80, p = 0.007). Mesh use did not cause significant reduction in recurrences > 2cm (OR 0.94, 95% CI 0.52-1.67, p = 0.83) or in reoperation rates (OR 0.64, 95% CI 0.39-1.07, p = 0.09). None of the specific meshes assessed were found to be superior in the reduction of recurrence or reoperation rates. Cases of mesh erosion with eventual foregut resection were noted and were associated with synthetic meshes only. Mesh reinforcement seemed protective against total recurrence in LHH although this has to be interpreted with caution given the level of heterogeneity introduced by the inclusion of observational studies in the analysis. There was no significant reduction in large recurrences (> 2cm) or reoperation rate. If the synthetic mesh is to be used patients need to be informed of the risk of mesh erosion.

With Aging, Obesity, And Hypothyroidism, Can GERD Lead to A Large Hiatal Hernia?

Hiatal hernia (HH) is a protrusion of the upper part of the stomach that is pushed into the thorax through an opening in the diaphragm. This paper mainly discusses causes of hiatal hernia, such as obesity, aging, and hypothyroidism, in a patient of 63 years old with a past medical history of hyperlipidemia, asthma, and anemia who complains of food being stuck in her chest along with emesis of food and cough. This paper's core is analyzing the causes of hiatal hernia and precise differential diagnoses.

Hiatal Hernia: The Great Masquerade in the Emergency Department.

Hiatal hernia (HH) can mimic different cardiovascular, pulmonary and neoplastic diseases.HH has a typical echocardiographic (2DE) presentation as an amorphous, echolucent mass with the appearance of a left atrial space-occupying lesion.Oral ingestion of a carbonated drink may help to distinguish between a large HH and an atrial mass by 2DE.

Laparoscopic Hiatal Hernia Repair With Concomitant Transoral Incisionless Fundoplication.

Patients with gastroesophageal reflux disease and a large hiatal hernia can have life-disrupting symptoms, such as heartburn, regurgitation, cough, and hoarseness. Gastroesophageal reflux disease symptoms are often treated with proton pump inhibitors and occasionally treated with surgery. The last decade has seen the development of a new procedure-laparoscopic hiatal hernia repair with concomitant transoral incisionless fundoplication. When transoral incisionless fundoplication is performed immediately after a laparoscopic hiatal hernia repair, it may enable the discontinuation of proton pump inhibitors and improve a patient's quality of life. This article explores the development of the transoral incisionless fundoplication procedure as well as its concomitant use after hiatal hernia repair at all stages of perioperative care. Also included is a hypothetical case study that illustrates the perioperative nursing care of a patient undergoing this procedure.