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The first step of the procedure is the abdominal reduction of HH contents by gentle traction of the hernia sac, proceeding gradually with extensive mediastinal mobilization of the esophagus with blunt dissection in order to obtain at least 2-2.5 cm of intra-abdominal esophageal length [Figure 1A and B] [21]

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Sackesen C, Ercan H, Dizdar E, Soyer O, Gumus P, et al: A comprehensive evaluation of the enzymatic and nonenzymatic antioxidant systems in childhood asthma