Introduction: In this video we present a case of laparoscopic paraesophageal hernia repair with biologic mesh, Nissen fundoplication and gastropexy to demonstrate the surgical approach and we discuss the use of biologic mesh in hiatal hernia repair.

Methods: The case is an 84 year old female who presents with increasing solid food dysphagia, heartburn, regurgitation, and chest pain. Upper GI endoscopy and upper GI radiological studies demonstrate a large type II paraesophageal hernia.

Results: The video demonstrates patient positioning, port placement, hiatal hernia dissection, gastric and distal esophageal mobilization, and hiatal closure. The hiatal hernia repair is further reinforced with placement of an acellular human dermal matrix mesh. A Nissen fundoplication follows along with an anterior gastropexy.

Conclusion: Biologic mesh, with its remodeling capabilities and the lack of leaving a foreign body in place long-term along with its short-term recurrence rate reduction should continue to be an interesting area of study in the repair of paraesophageal hernias.