During hiatal hernia surgery, the stomach and the esophagus are carefully separated from the diaphragm. With the esophagus and stomach detached from the diaphragm, the surgeon then tightens the hiatus, using sutures to bring the loose sides of the hiatus together.
Next, the surgeon wraps the upper part of the stomach around the esophagus. The surgeon uses sutures to attach the two sides of the upper stomach to each other, and then sutures the stomach to the esophagus to create a stronghold. Attaching the stomach to the esophagus will reduce the probability of future hiatal herniation.