Cargando…

Paraesophageal hernia: to fundoplicate or not?

The need for an antireflux procedure during repair of a paraesophageal hernia (PEH) has been the subject of a long-standing controversy. With most centers now performing routine fundoplication during PEH repair, high-quality data on whether crural repair alone or using a mesh may provide adequate an...

Descripción completa

Detalles Bibliográficos
Autores principales: Solomon, Daniel, Bekhor, Eliahu, Kashtan, Hanoch
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184421/
https://www.ncbi.nlm.nih.gov/pubmed/34164536
http://dx.doi.org/10.21037/atm.2020.03.106
_version_ 1783704584717336576
author Solomon, Daniel
Bekhor, Eliahu
Kashtan, Hanoch
author_facet Solomon, Daniel
Bekhor, Eliahu
Kashtan, Hanoch
author_sort Solomon, Daniel
collection PubMed
description The need for an antireflux procedure during repair of a paraesophageal hernia (PEH) has been the subject of a long-standing controversy. With most centers now performing routine fundoplication during PEH repair, high-quality data on whether crural repair alone or using a mesh may provide adequate anti-reflux effect is still scarce. We sought to answer to the question: “Is fundoplication routinely needed during PEH repair?”. Our endpoints were (I) rates of postoperative gastroesophageal reflux disease (GERD) (either symptomatic or objectively assessed), (II) rates of recurrence, and (III) rates of postoperative dysphagia. We searched the MEDLINE, Cochrane, PubMed, and Embase databases for papers published between 1995 and 2019, selecting comparative cohort studies and only including papers reporting the rationale for performing or not performing fundoplication. Overall, nine papers were included for review. While four of the included studies recommended selective or no fundoplication, most of these data come from earlier retrospective studies. Higher-quality data from recent prospective studies including two randomized controlled trials recommended routine fundoplication, mostly due to a significantly lower incidence of postoperative GERD. However, only a relatively short follow-up of 12 months was presented, which we recognize as an important limitation. Fundoplication did not seem to result in reduced recurrence rates when compared to primary repair alone.
format Online
Article
Text
id pubmed-8184421
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher AME Publishing Company
record_format MEDLINE/PubMed
spelling pubmed-81844212021-06-22 Paraesophageal hernia: to fundoplicate or not? Solomon, Daniel Bekhor, Eliahu Kashtan, Hanoch Ann Transl Med Review Article on Innovations and Updates in Esophageal Surgery The need for an antireflux procedure during repair of a paraesophageal hernia (PEH) has been the subject of a long-standing controversy. With most centers now performing routine fundoplication during PEH repair, high-quality data on whether crural repair alone or using a mesh may provide adequate anti-reflux effect is still scarce. We sought to answer to the question: “Is fundoplication routinely needed during PEH repair?”. Our endpoints were (I) rates of postoperative gastroesophageal reflux disease (GERD) (either symptomatic or objectively assessed), (II) rates of recurrence, and (III) rates of postoperative dysphagia. We searched the MEDLINE, Cochrane, PubMed, and Embase databases for papers published between 1995 and 2019, selecting comparative cohort studies and only including papers reporting the rationale for performing or not performing fundoplication. Overall, nine papers were included for review. While four of the included studies recommended selective or no fundoplication, most of these data come from earlier retrospective studies. Higher-quality data from recent prospective studies including two randomized controlled trials recommended routine fundoplication, mostly due to a significantly lower incidence of postoperative GERD. However, only a relatively short follow-up of 12 months was presented, which we recognize as an important limitation. Fundoplication did not seem to result in reduced recurrence rates when compared to primary repair alone. AME Publishing Company 2021-05 /pmc/articles/PMC8184421/ /pubmed/34164536 http://dx.doi.org/10.21037/atm.2020.03.106 Text en 2021 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article on Innovations and Updates in Esophageal Surgery
Solomon, Daniel
Bekhor, Eliahu
Kashtan, Hanoch
Paraesophageal hernia: to fundoplicate or not?
title Paraesophageal hernia: to fundoplicate or not?
title_full Paraesophageal hernia: to fundoplicate or not?
title_fullStr Paraesophageal hernia: to fundoplicate or not?
title_full_unstemmed Paraesophageal hernia: to fundoplicate or not?
title_short Paraesophageal hernia: to fundoplicate or not?
title_sort paraesophageal hernia: to fundoplicate or not?
topic Review Article on Innovations and Updates in Esophageal Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184421/
https://www.ncbi.nlm.nih.gov/pubmed/34164536
http://dx.doi.org/10.21037/atm.2020.03.106
work_keys_str_mv AT solomondaniel paraesophagealherniatofundoplicateornot
AT bekhoreliahu paraesophagealherniatofundoplicateornot
AT kashtanhanoch paraesophagealherniatofundoplicateornot