Traditionally, the crura are sutured together below the OG junction. However, the location of the hiatal hernia is always above the OG junction. So should we not perform the cruroraphy above the OG junction?
Below only. Keep going up suturing but leave a gap of one cm to accommodate the distal flow of Bonus.
Thanks for your reply sir. Can I ask why place the sutures below only?
If the suture is placed at hiatus, more so ,aimed to close the hiatus, always leads to dysphagia. If the suture is given tight. Same result. Better to leave 1 CM loose better.
- Begin suturing posteriorly or laterally below the OG junction, moving cranially as needed.
- Place the uppermost stitch at or slightly above the OG junction only if necessary to close the defect, ensuring no luminal compromise.
- confirm with intraoperative calibration (bougie, endoscopy).
Thanks for your input Mauricio. I use a 38F bougie in all of my cases to check free passage over the OJ junction. I noticed that in all my cases, if I place all the sutures posterior to the esophagus, there is difficulty in the bougie going through. So in my cases, I only place one suture posterior to the esophagus and two sutures anterior to the esophagus.
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