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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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2021
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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 |
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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 |