Laparoscopic antireflux procedures with hepatic shoulder technique for the surgical management of large paraesophageal hernias and gastroesophageal reflux disease

Background Large paraesophageal hernias are notoriously difficult to manage via laparoscopy and are associated with a significant recurrence rate. A novel laparoscopic approach was used to close the diaphragmatic defect in four patients diagnosed with large, paraesophageal hernias and gastroesophageal reflux disease symptomatology.