[Laparoscopic Hiatal Hernia Repair].

Esophageal hiatal hernia is a condition in which the esophageal hiatus opens and the stomach escapes from the abdominal cavity into the mediastinum. The basic surgical procedures are 1) return of the prolapsed stomach into the abdominal cavity, 2) suture of the dilated esophageal hiatus, and 3) fundoplication and fixation of the stomach to prevent gastroesophageal reflux disease (GERD). The Japanese guidelines for the treatment of GERD recommend laparoscopic Toupet fundoplication as the standard procedure, which we also follow. It is important to determine the position of ports by considering the angle at which the esophageal hiatus can be easily approached. The dissection of the hernia sac from the left side enables effective surgical procedure. In Toupet fundoplication, loosening the wrapping for the elderly is important to prevent dysphagia. Postoperative complications include aspiration pneumonia, delayed gastric emptying, and esophageal stricture. It is important to accurately understand the normal anatomy and the situation causing the hernia, and to perform a careful repair operation.