The role of gastropexy in paraesophageal hernia repair: A scoping review of current evidence.

Background: Paraesophageal hernias (PEH), involving abdominal components herniating through the esophageal hiatus, pose serious risks like obstruction and perforation, prompting SAGES to recommend repair upon symptom onset in 2013. Despite surgical advancements, high recurrence rates persist post-PEH repair. Gastropexy, securing the stomach to prevent re-herniation, emerges as a potential solution. However, consensus on its application is lacking. This review aims to map existing research, summarize evidence, and identify gaps guiding future gastropexy research in PEH repair.

Methods: Following PRISMA guidelines, this scoping review conducted a comprehensive literature search using PubMed, Cochrane, and Embase. Eligible studies, including RCTs, observational, and cohort studies, described gastropexy for PEH treatment in adults published in English after 2013. Articles were rigorously screened, with data extracted and organized into tables detailing study characteristics, conditions, and outcomes.

Results: A search yielded 343 studies on gastropexy for PEH, with 17 meeting inclusion criteria. Most were retrospective (47.1 %) or case series (41.2 %). GP, primarily in types III and IV hernias, was mainly performed laparoscopically. Anterior GP was most commonly used (in 64.7 % of included studies), with some studies using additional techniques. Reduced recurrence rates were seen when adjunct procedures such as fundoplication were performed with gastropexy.

Conclusion: This review highlights the varied application of gastropexy in PEH repair, aiming to reconcile differing surgeon opinions. The data suggests gastropexy can be safely utilised across different techniques, offering a viable option for addressing PEH and reducing hernia recurrence, particularly in high-risk cases.