No need for mesh in the repair of hiatal hernias: Autologous tissue hiatoplasty techniques for the repair of the complex diaphragmatic defect.

Abstract

Laparoscopic repair of complex diaphragmatic defects from a giant paraesophageal hernia or recurrent hiatal hernia remains challenging. Several techniques, including mesh use and diaphragmatic relaxing incisions, have been used to achieve reduced tension closure of the esophageal hiatus. In this report, we review multiple autologous tissue flap techniques for use in bridging versus onlay reinforcement to achieve closure of the crural defect with reduced tension. The falciform ligament flap, left triangular ligament flap, pars flaccida flap, sac hiatoplasty, and ligamentum teres flap offer multiple options for closure of complex diaphragmatic defects using well-vascularized autologous tissue. These are viable and reproducible techniques and may obviate the need for mesh use or diaphragmatic relaxing incisions, with their associated risks.