“Paraesophageal hernia repair remains a staple in the armamentarium of the foregut surgeon. Current literature suggests paraesophageal hernia repair should be approached
in a patient-centered, precision medicine manner. In general, hernia reduction, sac excision, and primary suture approximation of the hiatal crura are mandatory. Use of mesh should be based on individual risk factors; if mesh is used, biological meshes appear to have a more favorable safety profile, with the “reverse C” or keyhole configuration allowing for increase in crural tensile strength at it most vulnerable areas.”