Laparoscopic Approaches to Hiatal Hernia Repair
Summary
Laparoscopic repair of hiatal hernia has become the standard of care for symptomatic patients, combining minimal invasiveness with robust outcomes. Key techniques include fundoplication—wrapping the gastric fundus around the distal oesophagus—to restore the gastro-oesophageal barrier and prevent reflux. Variations such as Nissen (360°), Toupet (270° posterior) and Dor (180° anterior) fundoplication are selected according to motility studies and patient tolerance. Repair of the diaphragmatic crura (crurorrhaphy) restores the normal size of the oesophageal hiatus, often reinforced with prosthetic or biological mesh to reduce recurrence. Alternative adjuncts include anterior gastropexy, in which the stomach is sutured to the abdominal wall to prevent re-migration, and gastrostomy-based fixation in high-risk or elderly patients. Advances in suturing devices and three-dimensional imaging have enabled precise dissection and reconstruction while preserving vagal innervation. Robot-assisted platforms have broadened the surgeon’s dexterity in complex re-operations and emergency settings. Current debates centre on mesh type and fixation method, balancing recurrence reduction against mesh-related complications and dysphagia. Overall, laparoscopic strategies offer shorter hospital stay, faster recovery and lower wound morbidity compared with open surgery, and they remain adaptable to patient anatomy, hernia size and operative risk.
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Laparoscopic Approaches to Hiatal Hernia Repair publication trend
The graph below shows the total number of articles in laparoscopic approaches to hiatal hernia repair across all publications each year (not limited to Nature Index journals).
Technical terms
Fundoplication: Surgical wrapping of the gastric fundus around the lower oesophagus to reinforce the lower oesophageal sphincter and prevent reflux.
Crurorrhaphy: Suturing of the diaphragmatic crura to narrow and strengthen the oesophageal hiatus.
Mesh augmentation: Use of synthetic or biological scaffold material to reinforce crural repair and reduce hernia recurrence.
Gastropexy: Fixation of the stomach to the abdominal wall or diaphragm to prevent herniation or volvulus.
Paraesophageal hernia: A type of hiatal hernia in which the gastric fundus herniates alongside the oesophagus while the gastro-oesophageal junction remains in place.
References
- Systematic review and meta-analysis of laparoscopic mesh versus suture repair of hiatus hernia: objective and subjective outcomes. Surgical Endoscopy (2017).
- Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study. Journal of Robotic Surgery (2016).
- Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review. World Journal of Emergency Surgery (2020).
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