General Surgery

Paraoesophageal Hernia Repair (Laparoscopic)

OPERATION: Laparoscopic Repair of Paraoesophageal (Rolling) Hiatus Hernia
ANAESTHETIC: General anaesthesia
POSITION: Supine, legs split, head-up (reverse Trendelenburg). Surgeon between legs.

INDICATION:
Symptomatic type II / III / IV hiatus hernia. [Symptoms: dysphagia / volvulus / anaemia / intermittent obstruction].

PROCEDURE:
WHO Checklist performed. Five-port laparoscopic access established. Liver retractor placed.

Hernial contents reduced from mediastinum using Babcock forceps with gentle traction. [Adhesions in hernia sac divided as required]. Hernia sac dissected off right and left crura and mediastinal structures. Sac opened and excised. [Pleural entry encountered and managed: pneumoperitoneum released immediately / needle decompression / chest drain as appropriate].

Gastrohepatic ligament divided. Both crura dissected and displayed. Oesophagus encircled and elevated on Penrose drain. Sufficient intra-abdominal oesophageal length confirmed.

Short gastric vessels divided to mobilise fundus. Posterior cruroplasty performed with [number] × 2/0 non-absorbable sutures placed from inferior to superior, taking generous bites of each crus. [Mesh reinforcement applied for defects > 5 cm: [size] mesh secured to diaphragm with stapler]. Anterior crural sutures placed if required.

Floppy Nissen fundoplication created to prevent postoperative reflux [or partial wrap if oesophageal motility concerns].

Port sites closed. [Chest X-ray on table to exclude pneumothorax if pleural entry occurred].

FINDINGS:
Type [II / III / IV] hiatus hernia. Contents: [stomach / omentum / colon / spleen]. Hiatal defect [size]. Adequate intra-abdominal oesophageal length achieved.

EBL: Minimal. COMPLICATIONS: None [/ describe].

POST-OPERATIVE INSTRUCTIONS:
Soft diet for 4–6 weeks. Outpatient review at 6 weeks.