Hiatal hernia (HH) occurs when a portion of the stomach protrudes into the mediastinum through a weakened esophageal hiatus. Standard laparoscopic treatment involving reduction of the herniated stomach, cruroplasty, and fundoplication provides symptom relief but carries a high recurrence rate of 12–42%, even with mesh reinforcement. The phrenoesophageal ligament (PEL) plays a key role in maintaining the anatomical relationship between the esophagus and diaphragm, allowing independent motion during swallowing and respiration. This case report introduces the Alinasser technique—Phrenoesophageal Ligament Reconstruction with Mesh—as a novel approach to hiatal hernia repair. In a 34-year-old male, who was complaining of GERD for more than 10 years and not responding to PPI, a non-absorbable mesh measuring approximately 2.0 × 10.0 cm was sutured to the esophagus just above the hiatus with four 2-0 Prolene stitches and fixed anteriorly to the diaphragm with four additional stitches, securing half the mesh to each structure. Postoperatively, the patient experienced a smooth recovery, tolerated oral fluids by the first day, and resumed a normal diet without reflux or dysphagia at six months follow-up. This outcome suggests that reconstructing the PEL using mesh may improve anatomical stability, reduce recurrence rates, and minimize postoperative complications such as dysphagia or mesh-related erosion. Further clinical evaluation in larger patient populations is required to validate this technique and determine its potential role as a preferred surgical option for durable hiatal hernia repair.
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