Achieving Adequate Intra-Abdominal Esophageal Length and Tailored Cruroplasty in Laparoscopic Hiatal Hernia

After careful adhesiolysis between the esophagus and mediastinal structures, adequate mobilization of the distal esophagus is achieved to obtain approximately 1.5–2 cm of tension-free intra-abdominal esophagus. This step is critical to reduce the risk of postoperative hernia recurrence and reflux-related complications. Once satisfactory esophageal length is confirmed, posterior cruroplasty is performed using two to three interrupted sutures. The crural closure is intentionally not overly tight, allowing physiological movement of the esophagus while maintaining hiatal competence. Excessive narrowing of the hiatus is avoided to reduce the risk of postoperative dysphagia. This video demonstrates the balance between sufficient esophageal length and a tailored, non-constricting cruroplasty. The technique emphasizes anatomy-driven repair rather than rigid measurements.