Relaxing incision for paraesophageal hernia repair

For larger defects in which the crural fibers cannot be closed primarily, one can consider the use of relaxing incisions along the right or left crural muscle. This can facilitate closure around the esophagus. Our preference is to perform this along the right crus (illustrated) as this will often be covered by the left lateral lobe of the liver. We then would use mesh to reinforce the area of relaxation.