Outcomes of Hiatal Repair and Gastropexy Without Fundoplication in Paraoesophageal Hernia

Overview

This retrospective study evaluated 30 patients undergoing hiatal repair and gastropexy without fundoplication for paraoesophageal hernia (PEH). Despite a 30% rate of major postoperative complications, 75% of patients reported symptom resolution and 72% expressed satisfaction with the operation at a median follow-up of 38 months.

Background

Paraoesophageal hernias are associated with serious complications such as perforation and obstruction, often affecting elderly and fragile patients. Standard surgical repair typically includes fundoplication to prevent reflux but carries risks like persistent dysphagia and gas bloating. Gastropexy without fundoplication is an alternative approach aimed at reducing surgical trauma and postoperative dysphagia, especially in high-risk patients, but its long-term outcomes remain underreported.

Data Highlights

Key Findings

• 30% of patients experienced major postoperative complications (Clavien-Dindo grade III or higher).
• 23% of patients had paraoesophageal hernia recurrence requiring redo gastropexy.
• 75% of patients reported resolution of symptoms at median 38 months follow-up.
• Median GERD-HRQL score was low (4 out of 50), indicating good quality of life postoperatively.
• 72% of patients expressed satisfaction with the surgical outcome.
• Four patients developed new reflux symptoms after surgery, while four others had complete reflux resolution.

Clinical Implications

Hiatal repair with gastropexy without fundoplication offers a viable surgical option for PEH patients, particularly those who are elderly or have multiple comorbidities, by minimizing surgical trauma and avoiding fundoplication-related dysphagia. Although the procedure carries a notable risk of major complications and hernia recurrence, the majority of patients achieve symptom relief and report good quality of life long term.

Conclusion

Laparoscopic hiatal repair and gastropexy without fundoplication can provide effective symptom control and satisfactory quality of life in patients with paraoesophageal hernia, despite a significant complication and recurrence rate. This approach may be especially suitable for fragile patients where fundoplication risks outweigh benefits.

References

1. Society for Endoscopic Gastrointestinal Surgery (SAGES) Guidelines -- PEH Repair Recommendations
2. GERD-Health Related Quality of Life Questionnaire (GERD-HRQL) -- Validated Assessment Tool
3. Clavien-Dindo Classification -- Postoperative Complications Grading