Laparoscopic Paraesophageal Hernia Repair

Paraesophageal hernias should be thought of as separate entities from type 1 hiatal hernias. Surgical management of paraesophageal hernias remains the standard treatment for symptomatic hernias. Elective laparoscopic paraesophageal hernia repair is now the standard approach to the patient with a symptomatic paraesophageal hernia. The operation is technically challenging and requires numerous intra-operative and peri-operative considerations. Here, we will highlight the key points in the peri-operative and intra-operative management of paraesophageal hernias, emphasizing the operative goals of reduction of the hernia contents, excision of the hernia sac, a tension free repair with complete esophageal mobilization, crural repair, and antireflux operation.