Example of paraesophageal hernia on Endoscopy.This is the forward and reflexed view (Retrovision maneuver)in a patient demonstrating big paraesophageal hiatal hernia.
Use of T-fasteners for anterior gastropexy.
A 2-cm, 360 degree wrap is created using three interrupted, nonabsorbable sutures with care to avoid the anterior vagus.
The crural opening is closed with simple, interrupted nonabsorbable suture (0 Ethibond). For large defects, pledgets and/or bioprosthetic mesh may be used.
Dissection posterior to the esophagus within the mediastinum.
Dissection of the hernia sac away from the right crus.
Division of gastrohepatic ligament and exposure of the right crus of the diaphragm.