Laparoscopic repair of a giant hiatus hernia--how I do it

The laparoscopic approach is now the technique of choice for the repair of large hiatus hernia. It is associated with a low risk of complications. However, controversy exists as to the optimal technique for laparoscopic repair. In this paper, we describe our approach. This entails full dissection of the hernia sac from the mediastinum, hiatal repair with posteriorly placed sutures, and then construction of an appropriate fundoplication. Whether the use of mesh for hiatal repair will reduce the risk of subsequent reintervention and not add any new risks is, however, unclear. For this reason, we believe that the mesh should only be used in appropriately designed clinical trials, and for now, the standard approach to laparoscopic repair of a large hiatus hernia is sutured repair.