Because of experience with reherniation when large hiatal hernias were repaired with simple cruroplasty, Frantzides et alArticle performed a prospective, randomized controlled trial involving 72 individuals undergoing laparoscopic Nissen fundoplication with a hernia defect 8 cm or longer in diameter. Thirty-six patients underwent Nissen fundoplication with posterior cruroplasty, and 36 underwent Nissen fundoplication with posterior cruroplasty and circumferential onlay of PTFE mesh. Aside from a slightly longer operative time and an additional cost of $1000 in the prosthetic group, both clusters had similar hospital experiences, with a mean follow-up of 3 years (range, 6 months to 6 years). There was a recurrence rate of 22% in the cruroplasty-only group, as opposed to 0% in the PTFE-reinforced group. Thus, the use of mesh reinforcement is recommended.