Addition of Anterior Gastropexy Reduces Recurrence of Paraoesophageal Hernia

Petro CC, Ellis RC, Maskal SM, et al. Anterior Gastropexy for Paraesophageal Hernia Repair: A Randomized Clinical Trial. JAMA Surg. 2024.

Schlottmann F, Herbella FAM, Patti MG. Management of Paraesophageal Hernia—Still a Controversial Topic. JAMA Surg. 2024, in press.

Paraesophageal hernia can reduce quality of life and be associated with life-threatening complications. Minimally invasive paraesophageal hernia repair (MIS-PEHR) is recommended for most patients diagnosed with this condition, but recurrence rates are high.

This registry-based randomized prospective trial (n = 240) was conducted in three academic institutions. The authors hypothesized that anterior gastropexy added to paraesophageal hernia repair would reduce recurrence rates.

Patients were randomized to undergo anterior gastropexy as a component of MIS-PEHR or no gastropexy. The main outcome of interest was hernia recurrence defined as imaging evidence of migration of the stomach at least 2 cm above the diaphragm at 1 year post repair or reoperation during the first year of follow up.

The analysis showed that recurrence was diagnosed in 15% of patients who had anterior gastropexy and 36% of patients who did not have the added procedure. Quality of life outcomes were similar for both patient groups.

The authors concluded that adding anterior gastropexy should be the preferred method to reduce recurrence.

In the editorial that accompanied the article, Schlottmann and coauthors agreed that anterior gastropexy was an effective method for reducing recurrence. They also noted that fundoplication was used in a small proportion of patients reported in the study even though a sizable number of patients were diagnosed with reflux.