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Updated: Jun 9, 2025
10:52
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
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Fundoplication at the time of paraesophageal hernia repair does not decrease the rate of hernia recurrence or
Joshua Lyons1,2,3, Hamza Nasir Chatha4,5,6, Christina Boutros4,5,6
1Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA. Joshua.Lyons@UHHospitals.org.
Surgical Endoscopy
|October 24, 2024
Summary
Fundoplication during paraesophageal hernia (PEH) repair did not prevent recurrence or GERD, but increased dysphagia. Routine use is not supported for PEH repair without intraoperative abnormalities.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Paraesophageal hernia (PEH) repair aims to resolve symptoms and prevent recurrence.
- Fundoplication is sometimes performed concurrently with PEH repair to mitigate gastroesophageal reflux (GERD) and recurrence.
- Evidence supporting routine fundoplication during PEH repair remains limited.
Purpose of the Study:
- To evaluate the effectiveness and complications of fundoplication during PEH repair.
- To compare recurrence, reoperation, dysphagia, and GERD rates between PEH repair with and without fundoplication.
Main Methods:
- Retrospective cohort study of 1,155 patients undergoing PEH repair from 2010-2023.
- Patients were divided into two groups: those who had fundoplication and those who did not.
- Outcomes assessed included PEH recurrence, reoperation rates, and postoperative dysphagia and GERD.
Main Results:
- Fundoplication was performed in 610 patients (53%), while 545 (47%) did not undergo the procedure.
- Hernia recurrence occurred in 19% of the fundoplication group versus 12% in the no-fundoplication group (p=0.004).
- Postoperative dysphagia was higher with fundoplication (12% vs. 7%, p=0.002), with no difference in GERD rates (7% vs. 7%, p=0.93).
Conclusions:
- Fundoplication during PEH repair did not reduce hernia recurrence, reoperation rates, or postoperative GERD.
- The procedure was associated with increased rates of postoperative dysphagia.
- Routine fundoplication is not recommended for PEH repair when the gastroesophageal flap valve appears normal intraoperatively.
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