TY - JOUR
T1 - Management of paraesophageal hiatus hernia
T2 - recommendations following a European expert Delphi consensus
AU - Gerdes, Stephan
AU - Schoppmann, Sebastian F.
AU - Bonavina, Luigi
AU - Boyle, Nicholas
AU - Müller-Stich, Beat P.
AU - Gutschow, Christian A.
AU - Gisbertz, Suzanne Sarah
AU - Köckerling, Ferdinand
AU - Lehmann, Thorsten G.
AU - Lorenz, Dietmar
AU - Granderath, Frank Alexander
AU - Rosati, Riccardo
AU - Wullstein, Christoph
AU - Lundell, Lars
AU - Cheong, Edward
AU - Nafteux, Philippe
AU - Olmi, Stefano
AU - Mönig, Stefan
AU - Biebl, Matthias
AU - Leers, Jessica
AU - Zehetner, Joerg
AU - Kristo, Ivan
AU - Berrisford, Richard George
AU - Skrobić, Ognjan M.
AU - Simić, Aleksandar P.
AU - Pera, Manuel
AU - Grimminger, Peter Philipp
AU - Gockel, Ines
AU - Zarras, Konstantinos
AU - Nieuwenhuijs, Vincent Bernard
AU - Gossage, James A.
AU - the Hiatus Hernia Delphi Collaborative Group
AU - van Berge Henegouwen, Mark i.
AU - Stein, Hubert J.
AU - Markar, Sheraz R.
AU - Hueting, Willem Eduard
AU - Targarona, Eduardo M.
AU - Johansson, Jan
AU - Macaulay, Graeme D.
AU - Wijnhoven, Bas P. L.
AU - Benedix, Frank
AU - Attwood, Stephen E.
AU - Hölscher, Arnulf Heinrich
AU - Priego, Pablo
AU - Fuchs, Karl-Hermann
AU - Luyer, Misha D. P.
AU - Griffiths, Ewen A.
AU - Søvik, Torgeir Thorson
AU - Theodorou, Dimitrios
AU - Sgromo, Bruno
AU - Salo, Jarmo A.
AU - Singhal, Rishi
AU - Thorell, Anders
AU - Zaninotto, Giovanni
AU - Bitenc, Marko
AU - D’journo, Xavier Benoit
AU - Fullarton, Grant M.
AU - Horbach, Thomas
N1 - Funding Information:
For the Hiatus Hernia Delphi Collaborative Group: Suzanne Sarah Gisbertz6, Ferdinand Köckerling7, Thorsten G. Lehmann8, Dietmar Lorenz9, Frank Alexander Granderath10, Riccardo Rosati11, Christoph Wullstein12, Lars Lundell13,56, Edward Cheong14, Philippe Nafteux15, Stefano Olmi16, Stefan Mönig17, Matthias Biebl18, Jessica Leers19, Joerg Zehetner20, Ivan Kristo21, Richard George Berrisford22, Ognjan M. Skrobić23, Aleksandar P. Simić23, Manuel Pera24, Peter Philipp Grimminger25, Ines Gockel26, Konstantinos Zarras27, Vincent Bernard Nieuwenhuijs28, James A. Gossage29, Mark i. van Berge Henegouwen30,57, Hubert J. Stein31, Sheraz R. Markar32, Willem Eduard Hueting33, Eduardo M. Targarona34, Jan Johansson35, Graeme D. Macaulay36, Bas P.L. Wijnhoven37, Frank Benedix38, Stephen E. Attwood39, Arnulf Heinrich Hölscher40, Pablo Priego41, Karl-Hermann Fuchs42, Misha D.P. Luyer43, Ewen A. Griffiths44, Torgeir Thorson Søvik45, Dimitrios Theodorou46, Bruno Sgromo47, Jarmo A. Salo48, Rishi Singhal49, Anders Thorell50, Giovanni Zaninotto51, Marko Bitenc52, Xavier Benoit D’journo53, Grant M. Fullarton54, Thomas Horbach55
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/6
Y1 - 2023/6
N2 - 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.
AB - 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.
KW - Delphi survey
KW - Fundoplication
KW - Hiatus hernia
KW - Mesh
KW - Paraesophageal hernia
KW - Surgical technique
UR - https://www.scopus.com/pages/publications/85149128400
U2 - 10.1007/s00464-023-09933-8
DO - 10.1007/s00464-023-09933-8
M3 - Article
C2 - 36849562
SN - 0930-2794
VL - 37
SP - 4555
EP - 4565
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 6
ER -