Crural hiatoplasty with left liver buttress reinforcement for paraconduit hiatus hernia repair: early lessons from a single-center case series.

Paraconduit hiatus herniation (PHH) is an increasingly recognized complication following esophagectomy, particularly with the adoption of a minimally invasive approach. Although several prophylactic and repair strategies have been described, recurrence remains high with no clear consensus on the optimal method. In this article, we describe our experience of a novel technique for PHH repair combining hiatoplasty and liver buttress reinforcement, developed to achieve a tension-free repair using autologous tissue and avoiding the use of mesh. The technique was used for all patients presenting with PHH between April 2023 and April 2025. All procedures were performed using the novel technique under the primary care of one consultant surgeon at a tertiary esophagogastric unit. Six patients underwent seven PHH repairs during the study period. The median age was 66.5 years, and most cases (83.3%) occurred as a complication of minimally invasive esophagectomy for esophagogastric cancer. The median length of stay was 2 days (interquartile range 1-7). One patient, who presented in a compromised clinical condition, had a more complex postoperative course requiring intensive care support. The 30-day readmission rate was 14.3%. Symptom recurrence occurred in three of seven repairs (42.3%), but this was confirmed radiologically in only one case, resulting in a radiological recurrence rate of 14.3%. No in-hospital or 90-day mortality occurred. The technique proved feasible in this early single-center experience, with no associated mortality or major technique-specific morbidity and comparable recurrence rates to those reported in the published literature following PHH repair. Larger, multi-center studies with longer follow-up are required to validate its efficacy and establish its role in PHH management.