The operative findings of our case. Gastric and omental herniation is observed within a peritoneal-lined defect immediately lateral to the esophageal hiatus (a). The defect is clearly separated from the esophageal hiatus by the left crus of the diaphragm (b). The top of the gastric fundus, which was incarcerated, is friable (c). Interrupted nonabsorbable heavy sutures are used for closure of the parahiatal defect (d).