INTRODUCTION: The purpose of this report is to describe a tension-free repair we have used successfully in 12 @entity1 with large hiatal defects. It is based on the creation of a web-shoelace pattern of @entity7502 ( @entity7502 (  ); Ethicon, Somerville, NJ) suture of the crura that functions as a barrier, with the advantages of being stronger and more economical than a mesh without the potential complications that may follow mesh repair or suture repair of a large @entity357 without mesh. Despite a success rate of 85%-95% reported in large series with a mid- and long-term follow-up evaluation, significant complications have been associated with @entity357 repair. Some of these complications include a slipped Nissen repair with intrathoracic wrap migration and @entity357 , resulting from inadequate closure of the crura, fundoplication disruption, or dehiscence of the hiatoplasty. MATERIALS AND METHODS: From June 2013 to June 2014, we have used this technique on 12 @entity1 (6 @entity1 and 6 @entity1 ). Only @entity1 with a large @entity357 of >4   cm were enrolled in this study. All @entity1 underwent laparoscopic Nissen fundoplication and hiatoplasty using our technique. They were all severely symptomatic with @entity1282 , @entity158 , @entity354 , and respiratory symptoms at night. RESULTS: Of the 12 @entity1 who underwent this type of repair, all of them have reported good to excellent functional and symptomatic outcomes with minimal morbidity, no deaths, and no recurrence. CONCLUSIONS: It is our belief that when a correct repair of the hiatus is not achieved with three stitches, adding more sutures will not lead to a tension-free repair, and this hiatoplasty will have an increased risk of dehiscence. It is for this reason that we recommend using our technique instead of using simple nonabsorbable sutures or a prosthetic mesh.

XXXX Suture Web-Shoelace-Like Pattern: An Alternative to Avoid the Use of Mesh in the Repair of a Large @entity357 .

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'men'] @entity7502 :: ('MESH:D011126', 'Chemical') :: ['polypropylene', 'Prolene'] @entity357 :: ('MESH:D006551', 'Disease') :: ['hiatal hernia recurrence', 'hiatus hernia'] @entity158 :: ('MESH:D010146', 'Disease') :: ['retrosternal pain'] @entity1282 :: ('MESH:D003680', 'Disease') :: ['dysphagia'] @entity354 :: ('MESH:D005764', 'Disease') :: ['gastroesophageal reflux disease']
@entity7502 :: (MESH:D011126,Chemical) :: ['Prolene']
