Tension at the hiatus: the role of lengthening procedures and relaxing incisions in paraesophageal hernias

Abstract

Avoiding tension during hernia repair is the goal of every surgeon. In the setting of laparoscopic paraesophageal hernia (PEH) repair, tension along esophageal length (axial) and between the crura (radial) should be considered. The aim of this narrative review is to summarize the current knowledge on techniques for axial and radial tension assessment and possible minimization during laparoscopic PEH repair.