Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

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• dc.contributor.author Gerdes, Stephan
• dc.contributor.author Schoppmann, Sebastian F.
• dc.contributor.author Bonavina, Luigi
• dc.contributor.author Boyle, Nicholas
• dc.contributor.author Müller-Stich, Beat P.
• dc.contributor.author Gutschow, Christian A.
• dc.contributor.author Hiatus Hernia Delphi Collaborative Group
• dc.date.accessioned 2024-03-27T14:25:35Z
• dc.date.available 2024-03-27T14:25:35Z
• dc.date.issued 2023
• dc.description.abstract Aims: There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods: We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as "recommended" or "discouraged" if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled "acceptable" (neither recommended nor discouraged). Results: Seventy-two surgeons with a median (IQR) experience of 23 (14-30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15-36) and 40 (28-60) pHH-surgeries, respectively. After Delphi round 2, "recommended" strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified "discouraged" strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were "acceptable". Conclusions: This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.
• dc.format.mimetype application/pdf
• dc.identifier.citation Gerdes S, Schoppmann SF, Bonavina L, Boyle N, Müller-Stich BP, Gutschow CA, et al. Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus. Surg Endosc. 2023 Jun;37(6):4555-65. DOI: 10.1007/s00464-023-09933-8
• dc.identifier.doi http://dx.doi.org/10.1007/s00464-023-09933-8
• dc.identifier.issn 0930-2794
• dc.identifier.uri http://hdl.handle.net/10230/59601
• dc.language.iso eng
• dc.publisher Springer
• dc.relation.ispartof Surg Endosc. 2023 Jun;37(6):4555-65
• dc.rights © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Delphi survey
• dc.subject.keyword Fundoplication
• dc.subject.keyword Hiatus hernia
• dc.subject.keyword Mesh
• dc.subject.keyword Paraesophageal hernia
• dc.subject.keyword Surgical technique
• dc.title Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion