Surgery steps

The first step involves using a laparoscope to locate the hernia orifice in the region where the oesophagus passes through the diaphragm. Extensive dissection in the chest region then allows for the oesophagus to be mobilised and brought back to a more natural anatomical position. At this point the mesh implant is adjusted to precisely fit the size of the hernia orifice.

The mesh is then inserted with its central bridging section lying between the inner and outer limbs of the diaphragmatic cleft. The two flaps are positioned immediately adjacent to the oesophagus. The mesh implant now completely closes off this cleft, leaving just the natural anatomical space where the oesophagus passes through the diaphragm.

The next step involves approximating the inner and outer limbs of the diaphragmatic cleft so that the tissue is completely overlying the two flaps of the mesh. Now only the central bridging section can be seen.

At least two stitches are then placed through the two limbs of the diaphragm and around the underlying central bridging part of the mesh to fix everything in place.

The special shape and structure of the mesh implant with its two flaps and its central bridging part (now held between the two limbs of the diaphragm) ensure a stable closure of the hernial orifice.

Animation

Click here to see an animation demonstrating the individual steps of the surgery in a short video.