Giant hiatus hernia: closure of the difficult hiatus



Repair of the large hiatus hernia has been troubled by diaphragmatic hiatal repair failure and recurrence. Use of mesh repair may reduce recurrence at a cost of increased reoperative complications and mesh fistulation. Methods of hiatal closure facilitation are described.


Techniques and accompanying intra-surgery pictures are discussed here based on personal experience from within a service performing variable 100 giant hernia repairs annually.


Techniques for closure of a large hiatus without mesh repair are described with illustration, the purpose to expose various techniques utilized in a service performing more than 100 giant hernia repairs annually.


Techniques adopted and described in this article may facilitate both mesh and non-mesh repair of crural hiatal defects associated with giant hiatus hernia.

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Corresponding author

Correspondence to Gregory L. Falk MB.BS, FRACS, FACS.

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Conflict of interest

G.L. Falk, T.J. D’Netto, and S.C. Little declare that they have no competing interests.

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Prospective patient data were collated from a password-protected practice database and collated for publication. The database was approved by the institutional ethics (CH62/6/2011-092).

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Caption Electronic Supplementary Material

Video figure-of-eight suture left diaphragmatic recruitment taken during hiatus repaire. Video was taken using Stryker video camera

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Falk, G.L., D’Netto, T.J. & Little, S.C. Giant hiatus hernia: closure of the difficult hiatus. Eur Surg 51, 291–294 (2019).

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  • Giant Hiatus Hernia
  • Para-oesophageal
  • Recurrence
  • Hiatus repair
  • Technique