Aim:
To report the experience in the use of gasless laparoscopy (GLLS) in the treatment of patients with hiatal hernia (HH) that was accumulated in a specialized thoracic center.

Material and methods:
Operations were performed via 3-6 cm midline access in the epigastrium with a camera installed in the left hypochondrium. A laparolift provided with the traction on the edge of the midline wound. Hiatus was repaired with diaphragmatic pillars suturing without mesh emplacement. Patients with gastroesophageal reflux disease (GERD) underwent fundoplication. Operations were estimated concerning their duration, and complications and hernia recurrence development.

Results:
The analysis covers the results of treatment of 159 patients with primary and 7 recurrent HH, 112 women and 54 men with median age of 61 years, who underwent GLLS from October 2019 to July 2025 in the single thoracic centre. Among all instances, 57 (34.34%) met the criteria for large HH. The duration of operations with posterior esophageal cruroplasty and antireflux procedure, excluding cases of recurrent hernias, conversions, and intraoperative complications, was 227±59 min, and 313±69 min (p<0.001) for recurrent HH. Intraoperative complications occurred in nine cases, postoperative morbidity in 22. Recurrent HH emerged in seven patients; their occurrence is considering predictable in five.

Conclusions:
GLLS allows combining the advantages of minimally invasive and open surgery in the HH treatment. Our findings suggest that the method may be beneficial in large paraesophageal hernias, and in patients with severe comorbidities.