Editing Hiatal hernia (section)

=== Indications: ===

* Patients with volume reflux
* Symptoms respond to PPI
* GORD with negative test for     oesophageal dysmotility
** Lithotomy, both arms at      90deg. Surgeon between legs.
** Nathanson retractor to pull      up left lobe of liver
** Divide lesser omentum to      expose the right hiatal liver
*** Be aware of hepatic branch       of vagus nerve and aberrant left hepatic artery
** Dissect hernial sac and      completely remove from mediastinum - circumferential dissection
** Mobilise oesophagus
** Tension-free repair of      hiatal defect, generally without mesh. Mostly interrupted sutures - maybe
** Perform complete Nissen      fundoplication
** Anterior gastropexy to      reduce risk of reherniation