Hiatus Hernia Repair

Opening ligament between stomach and liver with exposure right side oesophagous
Mobilisation left side oesophagous and upper part of stomach
Oesophagous retracted superiorly showing wide defect (hole) in diaphragm
Closure of the hiatus hernia (diaphragmatic crus) with interrupted non absorbable surgical sutures
Upper part of stomach (fundus) pulled through behind the lower oesophagous
270 Toupet fundoplication completed

Mobilisation of the herniated stomach through a large diaphragmatic (hiatus hernia) defect
Stomach completely reduced between the spleen (left upper quadrant abdomen) and liver (right upper quadrant abdomen)
Dissection of the hernia sac with a harmonic scalpel (ultrasound powered cutting tool)
Laparoscopic view of the mediastinum (space in the chest between the lungs) after complete excision of the hernia sac
Closure of the hiatus hernia (diaphragmatic crus) with interrupted non absorbable surgical sutures
Diaphragmatic hiatus hernia completely closed
Hernia repair reinforced with placement of a special soft “V” shaped prosthesis fixed with fibrin glue
Repair completed by the formation of a partial anterior fundoplication (upper portion of the gastric wall wrapped in front of the oesophagous)
Final laparoscopic view of the stomach sitting in its correct position into the abdominal cavity and partially covered by the liver