What is the implication of a non-reducible hiatal hernia in a patient being considered for anti-reflux surgery?

May suggest need for a Collis gastroplasty

A: A non-reducible hiatal hernia implies a short esophagus and may require a modification of the planned surgery (Collis gastroplasty) or esophageal lengthening procedure but it can still be performed laparoscopically.B: Post-operative dysphagia is usually due to improper surgical technique such as an overly long or tight fundoplication. C: In the presence of a non-reducible hiatal hernia the addition of a Collis gastroplasty to the fundoplication results in lengthening of the esophagus which prevents post-operative recurrence of the hiatal hernia or disruption of the fundoplication.D: Provided that a Collis gastroplasty is performed in addition to the fundoplication most patients will have an excellent operative result.