ABSTRACT
A hiatus hernia is an acquired form of diaphragmatic hernia. There are two types, sliding and rolling or paraoesophageal. In sliding, the gastro-oesophageal junction slides through the oesophageal opening of the diaphragm, predisposing to reflux and Barrett's oesophagitis. In rolling or paraoesophageal, the gastro-oesophageal junction remains in position, but an area of stomach and peritoneum slides up alongside the oesophagus into the thorax. Nissen's fundoplication surgery is performed in over 95% of patients. Other operations include Belsey Mark IV and Hill gastropexy. Nissen's fundoplication can be performed either laparoscopically or via an upper midline incision. In the laparoscopic operation a pneumoperitoneum is created via open technique, with the first 10-mm port being created subumbilically and four further operating ports being placed in a semi-circle opposite the xiphoid process. The fundus and greater curvature of the stomach are freed by dividing the short gastric vessels. The freed fundus is passed behind and then to the left of the oesophagus.
