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We appreciate the interest shown [5] by Granderath et al. The primary goal of our article was to describe our technique of placing a large knot in the tail end of all of our sutures so that the suture cannot pull through pledgets or tissue. We always place a large double knot at the end of the sutures that we place laparoscopically. Thus, it was not our goal to discuss the technique that we use for crural closure. The high rate of hiatal hernia recurrence after laparoscopic repair remains a vexing problem. Any technique that can be shown to reliably lower the long-term recurrence rate in a safe fashion has great value to patients and surgeons. …