Guidelines for Intraoperative Assessment of Type I Sliding Hiatal Hernias

The vast majority of hiatal hernias are called type I, or sliding hiatal hernias. In this type, the stomach intermittently slides up into the chest through a small opening in the diaphragm. In type I hernias (sliding hiatal hernias), the gastroesophageal junction migrates above the diaphragm. The stomach remains in its usual longitudinal alignment and the fundus remains below the gastroesophageal junction. Intraabdominal esophagus can not be seen or is shorter tha 2 cm.The operative procedure:first, complete hernia sac dissection was performed. Then, the length of tension-free intra-abdominal esophagus was measured to ensure that it was at least 2 cm in length; if this length was shorter than 2 cm, modified Collis gastroplasty was performed. Subsequently,crural re-approximation and then Nissen (360°) fundoplication was performed.For crural closure, only interrupted 2or 3 simple suture (Monofilament Polypropylene suture 2-0) was performed without reinforcement using mesh.