Mesh at the Hiatus: Where Do We Stand Now?

Abstract Laparoscopic hiatus hernia (HH) repair generally produces excellent outcomes, yet recurrence after primary suture cruroplasty—especially in large or recurrent hernias—remains a challenge. Mesh reinforcement has been proposed to improve durability, but its role is controversial due to risks of erosion, fibrosis, and stricture in the anatomically constrained hiatus. This review summarizes current evidence on the benefits and limitations of mesh use in HH repair, comparing synthetic, biologic, and biosynthetic materials and the techniques employed. Primary hiatal closure will be possible in most hiatus hernia repairs and this article outlines the tips and tricks one needs to follow, in order to achieve this.