Abstract
Crus closure failure with recurrent hiatal hernia is the proverbial Achilles heel of antireflux surgery, occurring in more than two-thirds of patients undergoing reoperative antireflux surgery. Success with use of synthetic mesh for ventral and inguinal hernias led to its use in hiatal hernia repair procedures. This was supported by improved short-term outcomes. Biologic prostheses were advocated to diminish the complications associated with synthetic mesh. Mesh-associated complications are often catastrophic and frequently require esophagogastric resection. In addition, long-term results do not support the initial improved outcomes with mesh use and have cast a cloud over their routine use. In this chapter we discuss the various aspects of mesh use for hiatus reinforcement.