Prospective randomized controlled trial to identify a sub-set of patients that do not benefit from the routine addition, and added morbidity, of a fundoplication during laparoscopic paraesophageal hernia repair.

Prospective Randomized Controlled Trial in which patients who meet criteria will be randomized to receive a concurrent fundoplication or no fundoplication at the time of paraesophageal hernia repair. Patients with known objective gastroesophageal reflux disease prior to surgery, those found to have a short esophagus in the operating room or defective gastroesophageal reflux barrier by intra-operative impedance planimetry measurements and/or endoscopic valve grade will be excluded.

Inclusion Criteria:

• Patients undergoing laparoscopic paraesophageal hernia repair

Exclusion Criteria:

• History of a prior hiatal hernia/paraesophageal hernia repair
• Patients with objective GERD preoperatively
• Intra-operative short esophagus
• Defective gastroesophageal reflux barrier as determined by impedance planimetry (FLIP)
• Defective gastroesophageal reflux barrier as determined by intra-operative endoscopy