To evaluate the safety and efficacy of laparoscopic hiatal hernia repair (LHHR) based on infracardiac bursa in the treatment of massive hiatal hernia (MHH), and to provide evidence-based reference for clinical practice.

A retrospective analysis of clinical data from January 2021 to December 2024 of 40 MHH patients in Hernia and Obesity Surgery at the First Hospital, Affiliated with the University of Science and Technology of China, who received surgical treatment based on infracardiac bursa for massive hiatal hernia repair under laparoscopy. The changes of reflux symptoms before and after surgery were assessed by gastroscopy and the gastroesophageal reflux disease questionnaire (GERD-Q). The main study indicators were right-sided pleural rupture and esophageal muscle injury results during surgery, and diverticulation. Secondary indicators included postoperative complications and length of hospital stay.

Of the 40 patients, 2 (5%) were lost to follow-up, and the median follow-up time was 24 (4-48) months. One died of acute cerebral infarction two months after discharge. Twenty-eight patients successfully identified the structure of the infracardiac bursa during surgery, and none suffered rupture of the right pleural membrane or damage to the oesophageal muscles. A further 12 patients failed to identify the infracardiac bursa, including five with a rupture of the right pleural membrane and one with damage to the oesophageal muscle. The median hernia defect diameter was 4.5 (4.5-5.0) cm, the median operative duration was 108 (60-310) min, and the median intraoperative bleeding was 10 (10-50) ml. The median indwelling time was 2 (1-7) days, and the median postoperative hospital stay was 3.5 (2.5-4.5) days. The average score of GERD-Q was (11.38±0.98) points preoperatively and decreased to (7.57±0.73) points postoperatively (P<0.001).

Based on infracardiac bursa, laparoscopic hiatal hernia repair can effectively reduce the rupture of the pleura and damage to the muscles of the esophagus during surgery, and improve surgical safety.