Autologous Dermis Graft Implantation: A Novel Approach to Reinforcement in Giant Hiatal Hernias

Figure 3

Surgical steps for giant hiatal hernia repair with dermis graft reinforcement: (a) initial intraoperative finding during redo surgery, 60% of the stomach is in the thoracic cavity; (b) adhesiolysis; (c) retraction of the mobile lesser curvature into the abdominal cavity; (d) stomach in the intra-abdominal position; (e) visualization of the crural stitch failure; (f) Belsey rear suture line left in place, fundoplication adequately mobilized; (g) suture repair of the defect; (h) harvesting site for dermis graft; (i) deepithelized skin flap; (j) dermis graft free of adipose tissue; (k) graft introduced into the abdomen; (l) graft fixation to the left diaphragmatic crura; (m) graft fixation to the right diaphragmatic crura; (n) excess graft removed; (o) anterior Dor’s fundoplication; (p) final position of fundoplication wrap and the reinforced hiatal repair; (q) scar at 1-month follow-up.