Management controversies for paraesophageal hernia

“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.”

Hiatal hernias are categorized into four types (Rogers)
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