Importance of Dissection of the Hernial Sac in Laparoscopic Surgery for Large Hiatal Hernias

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Abstract
TRADITIONALLY, large hiatal hernias have been repaired using an open procedure through either a thoracotomy or an upper midline abdominal incision. These approaches can be associated with substantial morbidity. Laparoscopic surgery has recently become established1 as the preferred surgical approach for gastroesophageal reflux disease, with the reduction and repair of any associated small hiatal hernia being an integral part of the laparoscopic procedure. The advantages of reduced morbidity and a shortened postoperative hospital stay1,2 would also be expected in patients with large hiatal hernias who are successfully managed laparoscopically, and early laparoscopic experience with the repair of large hiatal hernias has been reported.3-8