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Updated: Mar 19, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Defining Clinically Significant Radiographic Recurrence after Paraesophageal Hernia Repair: Post Hoc Analysis of
William C Bennett1, Ryan C Ellis1, Mahamed O Mohamed1
1From the Department of General Surgery, Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation; Cleveland, OH (Bennett, Ellis, Mohamed, Conner, Tu, Miller, Beffa, Krpata, Prabhu, Petro).
Background:
Radiographic recurrence after minimally invasive paraesophageal hernia repair (MIS-PEHR) is frequently defined as more than 2 cm of gastric herniation above the diaphragm, although this threshold was historically pragmatic rather than outcomes based. We evaluated whether recurrence size correlates with reoperation and patient-reported outcomes to support a clinically meaningful definition.
Study Design:
Post hoc analysis of a prospective randomized clinical trial (NCT04007952) including adults with paraesophageal hernia more than 5 cm undergoing MIS-PEHR (June 2019 to July 2023). Of 234 patients eligible for 1-year follow-up, 174 (74.4%) had imaging and reoperation data. Recurrence was categorized as 0 cm (n = 111), 0 to 2 cm (n = 10), 2 to 5 cm (n = 40), or more than 5 cm (n = 13). Outcomes included reoperation within 1 year and GERD Health-Related Quality of Life and Foregut-Associated Symptoms Likert scores.
Results:
Six patients (2.5%) underwent reoperation. No reoperations occurred with recurrence less than 2 cm; rates were 7.5% (3 of 40) for 2 to 5 cm and 23.1% (3 of 13) for more than 5 cm recurrences (p < 0.0001). Median GERD Health-Related Quality of Life total score was 3.0 [1.0 to 5.0] for 0 cm, 6.0 [3.0 to 16.0] for 2 to 5 cm (p = 0.0001 vs 0 cm), and 14.5 [2.0 to 32.0] for more than 5 cm (p = 0.0026 vs 0 cm); 0 to 2 cm recurrences did not differ from 0 cm (p = 0.13). Heartburn scores were similarly higher in both more than 2 cm groups (p ≤ 0.0005). Total Foregut-Associated Symptoms Likert scores differed across groups (p = 0.019), driven by worse symptoms in the more than 5 cm group. No differences were observed between the 2 to 5 cm and more than 5 cm groups.
Conclusions:
Radiographic recurrence more than 2 cm was associated with higher reoperation rate and worse patient-reported outcomes at 1 year, whereas 0 to 2 cm recurrences were not. These data support more than 2 cm as a clinically significant definition of recurrence after MIS-PEHR, whereas the relevance of smaller recurrences remains uncertain.
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