ArticleHernia : the journal of hernias and abdominal wall surgery2023
Trends in outcomes of 862 giant hiatus hernia repairs over 30 years.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Vonoprazan in erosive esophagitis: Influence of gender and hiatus hernia on outcomes.Pakistan journal of medical sciences · 2026Article
- Evaluation of the safety and effectiveness of crural reinforcement with bio-aHernia : the journal of hernias and abdominal wall surgery · 2025Article
- Association Between Large Hernia Size and Severe Postoperative Complications After Type III/IV Hiatal Hernia Repair.Cureus · 2025Article
- Body mass index should be considered as an indicator for laparoscopic surgery or robot-assisted surgery selection in patients with hiatal hernia.Journal of thoracic disease · 2025Article
- Does practice make perfect? Studying the relationship between surgeon experience and patient outcomes for paraesophageal hernia repairs.Surgical endoscopy · 2024Article
- Recurrence in Paraesophageal Hernia: Patient Factors and Composite Surgical Repair in 862 Cases.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2023Article
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Authors and funding
5 authors.
Funding
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Abstract
purposeLaparoscopic giant hiatus hernia repair is technically difficult with ongoing debate regarding the most effective surgical technique. Repair of small hernia has been well described but data for giant hernia is variable. This study evaluated trends in outcomes of laparoscopic non-mesh repair of giant paraesophageal hernia (PEH) over 30 years.
methodsRetrospective analysis of a single-surgeon prospective database. Laparoscopic non-mesh repairs for giant PEH between 1991 and 2021 included. Three-hundred-sixty-degree fundoplication was performed routinely, evolving into "composite repair" (esophagopexy and cardiopexy to the right crus). Cases were chronologically divided into tertiles based on operation date (Group 1, 1991-2002; Group 2, 2003-2012; Group 3, 2012-2021) with trends in casemix, operative factors and outcomes evaluated. Hernia recurrence was plotted using weighted moving average and cumulative sum (CUSUM) analysis.
results862 giant PEH repairs met selection criteria. There was an increasing proportion of "composite repair" after the first decade (Group 1, 2.7%; Group 2, 81.9%; Group 3, 100%; p < 0.001). There were less anatomical hernia recurrence (Group 1, 36.6%; Group 2, 22.9%; Group 3, 22.7%; p < 0.001) and symptomatic recurrence (Group 1, 34.2%; Group 2, 21.9%; Group 3, 7%; p < 0.001) over time. The incidence of anatomical recurrence declined over time, decreasing from 30.8% and plateauing below 17.6% near the study's end. Median followup (months) in the first decade was higher but followup between the latter two decades comparable (Group 1, 49 [IQR 20, 81]; Group 2, 30 [IQR 15, 65]; Group 3, 24 [14, 56]; p < 0.001). There were 10 (1.2%) Clavien-Dindo grade ≥ III complications including two perioperative deaths (0.2%).
conclusionHernia recurrence rates decreased with increasing case volume. This coincided with the increasing adoption of "composite repair", supporting the possible improvement in recurrence rates with this approach.
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