Cruroplasty

Cruroplasty is a surgical procedure that repairs the diaphragmatic crura—the left and right bands of muscle forming the esophageal hiatus in the diaphragm. The procedure is commonly performed as part of repair for hiatal hernias and for management of gastroesophageal reflux disease (GERD). By tightening or reconstructing the hiatus, cruroplasty reduces the size of the opening through which the esophagus passes, helping to prevent herniation and reflux.

Indications include sliding hiatal hernias with reflux, paraesophageal hernias, and persistent GERD symptoms despite medical therapy, particularly when accompanied by an anatomical defect of the esophageal hiatus. It is often performed during anti-reflux surgery such as Nissen or partial fundoplication to restore the barrier between stomach and esophagus.

Technique: Most cruroplasties are done laparoscopically. After reducing the hernia sac and mobilizing the lower esophagus, the crura are approximated with interrupted sutures, bringing the diaphragmatic crura together behind the esophagus. In large defects, mesh reinforcement may be used to prevent recurrence. The procedure is frequently followed by a fundoplication to augment the anti-reflux barrier.

Outcomes and risks: For appropriately selected patients, cruroplasty with fundoplication provides relief of reflux symptoms and improved esophageal function. Risks include injury to surrounding structures (esophagus, stomach, vagus nerves), pneumothorax, dysphagia, gas-bloat syndrome, and recurrence of hernia. Mesh-related complications may occur if mesh is used.

Recovery and alternatives: Most patients recover within days to weeks after laparoscopic surgery, with gradual diet advancement. Alternative approaches include simple hiatal hernia repair without fundoplication or non-surgical management for asymptomatic hernias.