Laparoscopic Hiatal Hernia Repair With Mesh Cruroplasty

The procedure was performed laparoscopically under general anesthesia with the patient in a 30° reverse Trendelenburg position. Following pneumoperitoneum and five-trocar insertion, any adhesions from the previous Sleeve Gastrectomy (LSG) were released to expose the hiatus. Dissection: The gastrohepatic ligament was divided, and the hernia sac and gastroesophageal fat pad were fully reduced into the abdomen while preserving the hepatic branch of the vagus nerve. Repair: The crural defect was closed using 2-3 interrupted non-absorbable sutures to achieve a tension-free repair. Mesh Augmentation: A shaped polypropylene mesh was placed in an "onlay" fashion over the posterior crural repair, secured with endoscopic metal fixators, and covered with the remaining hernia sac flaps to protect the esophagus. Closure: After confirming hemostasis, trocars were removed and ports closed. Postoperative Management: Patients followed a standardized protocol involving gradua