Outcomes of hiatal closure with surgical gastropexy alone for large paraesophageal hernia without significant reflux.

backgroundParaesophageal hernia (PEH) repair is usually performed with fundoplication. Historically, hiatal hernia repair without fundoplication was proposed but abandoned due to high anatomical recurrence and gastroesophageal reflux disease (GERD) rates. Modern comparisons are limited among dissimilar groups with mixed conclusions. We compared objective and symptomatic outcomes of hiatal hernia repair with gastropexy (HH-G) to a matched group of hiatal hernia repair with fundoplication (HH-F) for patients with large PEH without significant reflux.

methodsWe conducted a propensity matched analysis of patients undergoing minimally invasive HH-G to patients undergoing HH-F between 1/2010 and 12/2022. We included all patients with PEH ≥ 5 cm with non-reflux dominant symptomology excluding those with objective GERD. The 63 HH-G were matched 1:1 for age, BMI, and hernia type to 225 HH-F. The primary outcomes were recurrence (> 2 cm) and GERD health-related quality of life (GERD-HRQL).

resultsPatient demographics, hernia type, and size were similar except HH-G were slightly older. HH-G was used more during urgent repairs with less Collis gastroplasty and relaxing incision use. Median imaging follow-up was 22 (IQR:11-38) months. Anatomical recurrence (HH-G: 7/39 [14.6%] vs. HH-F: 8/48 [20.5%], p = 0.467) and symptomatic recurrences (1/36 [3%] vs. 3/42 [6%], p = 0.625) were similar between the groups. Post-operative GERD-HRQL scores were similarly low (2.0 [IQR:1.0-9.0] vs. 2.0 [IQR: 0.0-4.0], p = 0.289).

conclusionHiatal hernia repair with gastropexy results in seemingly similar quality of life and recurrence to a matched group of fundoplication for patients with large PEH without significant reflux, suggesting that this approach may be a treatment alternative in selected patients during PEH repair.