• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Diaphragmatic Relaxing Incisions During Laparoscopic Paraesophageal Hernia Repair

Diaphragmatic Relaxing Incisions During Laparoscopic Paraesophageal Hernia Repair

Christina L Greene, MD, Steven R DeMeester, MD, Joerg Zehetner, MD, Daniel S Oh, MD, Jeffrey A Hagen, MD

Keck Hospital of the University of Southern California, Los Angeles, CA

INTRODUCTION: Laparoscopic paraesophageal hernia (PEH) repair is associated with a high recurrence rate. In a recent randomized trial the recurrence rate exceeded 50% at five years. Similar to repair of other hernias, minimizing tension is a critical factor in preventing recurrence with PEH repair. At the hiatus, tension can occur secondary to a shortened esophagus or widely splayed crura. A Collis-Gastroplasty can address esophageal shortening while diaphragmatic relaxing incisions can address crural tension. The aim of this study is to describe the technique and review the outcomes of laparoscopic diaphragmatic relaxing incisions in patients undergoing PEH repair.

METHODS AND PROCEDURES: Records were reviewed to identify patients who had a relaxing incision during laparoscopic PEH repair. We considered patients to have a PEH when 50% or more of the stomach was intra-thoracic. The right relaxing incision was performed by opening the right crus next to the inferior vena cava, saving a 3 mm cuff of tissue along the cava to allow a patch to be sewn into place. The incision was full-thickness into the right pleural space, starting halfway up the right crus and stopping just below the anterior crural vein (Figure 1). The left relaxing incision starts lateral to the hiatus and follows the course of the rib laterally, typically beyond the spleen (Figure 2). The defect in each case was repaired with a suitably sized 1 mm Gortex patch (Figure 3 & 4). Patients were followed by chest X-Ray and videoesophagram at three months and annually.

RESULTS: From November 2010 to May 2012, 57 patients had PEH repair and 12 had a relaxing incision to accomplish crural closure. Eight patients were women and four were men, with a mean age of 72 years (58-84). The relaxing incision was right-sided in ten, left-sided in one and bilateral in one patient. All procedures were completed laparoscopically and included a fundoplication. In six patients a wedge- fundectomy Collis-Gastroplasty was performed. There were no major complications. At a median follow-up of 11.8 months, one patient had an asymptomatic mildly elevated right hemidiaphragm. All 12 patients had intact fundoplications without recurrent hiatal hernia or evidence of diaphragmatic disruption.

CONCLUSION: Crural tension likely contributes to the high recurrence rate noted with laparoscopic PEH repair. Relaxing incisions allow crural approximation with good short term outcomes and no major complications. Advanced laparoscopic surgeons should be aware of this option when faced with a large hiatus in a patient with PEH.


Session: Podium Presentation

Program Number: S063

3,174

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals