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Aiolfi et al. Mini-invasive Surg 2022;6:39 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.29

Review Open Access

Tension at the hiatus: the role of lengthening

procedures and relaxing incisions in
paraesophageal hernias

Alberto Aiolfi, Andrea Sozzi, Davide Bona

Department of Surgery, Istituto Clinico Sant’Ambrogio, University of Milan, Milan 20121, Italy.
Correspondence to: Dr. Alberto Aiolfi, Department of Surgery, Istituto Clinico Sant’Ambrogio, Via Luigi Giuseppe Faravelli 16,
University of Milan, Milan 20151, Italy. E-mail: alberto.aiolfi86@gmail.com
How to cite this article: Aiolfi A, Sozzi A, Bona D. Tension at the hiatus: the role of lengthening procedures and relaxing incisions
in paraesophageal hernias. Mini-invasive Surg 2022;6:39. https://dx.doi.org/10.20517/2574-1225.2022.29

Received: 31 Mar 2022 First Decision: 5 May 2022 Revised: 23 May 2022 Accepted: 8 Jun 2022 Published: 4 Jul 2022
Academic Editor: Giulio Belli Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
Avoiding tension during hernia repair is the goal of every surgeon. In the setting of laparoscopic paraesophageal
hernia (PEH) repair, tension along esophageal length (axial) and between the crura (radial) should be considered.
The aim of this narrative review is to summarize the current knowledge on techniques for axial and radial tension
assessment and possible minimization during laparoscopic PEH repair.

Keywords: Short esophagus, Collis gastroplasty, diaphragmatic relaxing incision, minimally invasive

INTRODUCTION
Laparoscopic paraesophageal hernia (PEH) repair is one of the most challenging procedures facing
minimally invasive surgeons. Exhaustive consideration of the operation principles is necessary for long-
term symptom relief, quality of life improvement, and recurrence minimization. Hernia relapse has been
reported up to 50% in medium/long-term follow-up depending on definition, patient characteristics (i.e.,
body mass index), technical aspects (i.e., esophageal lengthening, sac excision, gastropexy, mesh
reinforcement, etc.), surgeon experience, and hospital volumes .
[1-3]

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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