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Hiatal hernias occur when there is a widening of the diaphragmatic hiatus between the left and right crura that leads to an upward displacement of abdominal contents into the mediastinum. The presence of a hiatal hernia can be asymptomatic or be associated with severe symptoms such as heartburn, regurgitation, dysphagia, abdominal pain, and even atypical symptoms like cough and hoarseness. Unlike abdominal wall hernias such as inguinal or ventral, hiatal hernias are more dynamic due to the continuous diaphragmatic motion that creates friction at the esophageal and stomach interface and due to the pressure difference between chest and abdomen. As a result, the recurrence rates following surgical repair of hiatal hernias compared to other abdominal wall hernias is significantly higher and continues to rise over time. To improve outcomes, several modifications of the closure technique utilize adjuncts such as synthetic mesh, absorbable mesh, and pledgets and are incorporated into these repairs. This review provides an evidencebased assessment of the key advantages and disadvantages of each adjunct in the treatment of hiatal hernias.

Techniques for closing the hiatus: mesh, pledgets and suture techniques