الفهرس 
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Abstract
Summary and Conclusion
Hiatal hernias occur when abdominal contents are herniated from abdomen to the mediastinum. Its incidence in correlated with increased BMI and age. We found in our study that its symptoms are variable from patient to another.
We have found that hiatal hernia is associated with GERD in almost all the cases either symptomatically, endoscopically or by biopsy. GERD is characterized by progressive disruption of GEJ structure and function in addition to its associated dysplastic changes. Symptomatic patients an addition to patients having GERD all require surgical repair.
We have dealt in our study with 180 cases of various degrees of hiatal hernia. All patients were assessed in our study by upper endoscopy in addition to important radiological investigations as Barium oesophagogram and CT with oral contrast also ambulatory PH study to confirm diagnosis of reflux. Assessment of oesophageal motility disorders by high resolution manometry besides physiological assessment of fitness to surgery and anaesthsia.
Laparoscopic anti-reflux surgery is mandatory for hiatal hernia and GERD. A major concern of anti-reflux surgery is its technique. Because of recurrence observed of many cases, reinforcement of the hiatal defect by many ways is studied and practiced in many cases. Regarding use of synthetic mesh, it is still questionable whether to use or not. Many complications of mesh repair has been recorded nevertheless. As adhesions, migration, fibrosis or perforation.
In our study we used the round ligament of the liver to support and reinforce crural repair. We believe that in this study the use of the round ligament of the liver not only support hiatal hernia repair by using its own tissue, but also the ligamentum teres which is fatty tissue is covered by the peritoneum from both sides. The round ligament support crural repair in addition it fills the posterior part to the oesophagus leaving no place for anterior weakness.
There is still superiority of using patient’s own tissue for hiatal repair than using mesh repair. On the other hand, we have recorded few cases of recurrence in the study compared to previous studies 8% . we have noticed that using the round ligament reinforcement is completely safe, useful and cost effective with no need for additional instruments than usual instruments used in classic repair.
Postoperative symptomatic improvement was clearly noticeable with 35% of the cases having mild postoperative reflux symptoms and dysphagia which is reduced by time and required nothing than anti-secretory drugs postoperatively.