Background
Laparoscopic antireflux surgery is an established treatment for gastroesophageal reflux disease (GERD), especially when symptoms persist despite long-term medication or when patients prefer a durable surgical option. In addition to controlling reflux, surgery may also address hiatal hernias, which occur when part of the stomach moves upward through the diaphragm into the chest. Large and recurrent hiatal hernias are particularly challenging because the tissue at the hiatus often has to be repaired under significant tension.
In difficult redo operations, as well as in giant hiatal hernias and paraesophageal hernias, recurrence remains a major concern. Standard repair techniques sometimes fail because the crura of the diaphragm cannot be brought together without strain. Mesh reinforcement has been used widely, but long-term data have not consistently shown that it prevents recurrence. For this reason, surgeons continue to explore techniques that reduce tension on the repair itself.
