Our Summary

This paper is about a condition called paraesophageal hernia (PEH), which happens when parts of the abdomen push through a gap in the diaphragm. This can lead to serious problems like blockages and tears. In 2013, experts recommended fixing this as soon as symptoms appear. Despite improvements in surgery, there is still a high chance the hernia will come back after the repair. One possible solution is a procedure called gastropexy, which involves securing the stomach to prevent the hernia from reoccurring. However, there is no consensus on when to use this procedure. This paper aims to review existing research, summarize the evidence, and identify areas where more research is needed.

The researchers used three databases to find relevant studies. They only included studies that were about using gastropexy to treat PEH in adults, and that were published in English after 2013. They ended up with 17 studies. Most of these used a procedure called anterior gastropexy, and some used additional techniques. The studies showed that if other procedures were carried out alongside gastropexy, the chances of the hernia reoccurring were reduced.

The researchers concluded that gastropexy is a safe and effective option for treating PEH and reducing the chance of it coming back, particularly in high-risk cases. However, more research is needed to reconcile differing opinions among surgeons.

FAQs

  1. What is a paraesophageal hernia (PEH) and what complications can it cause?
  2. What is gastropexy and how can it help in the treatment of PEH?
  3. What did the researchers conclude about the effectiveness of gastropexy in treating PEH?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hernia repair is to follow post-operative instructions carefully, including avoiding heavy lifting and strenuous activity for a certain period of time. This will help ensure proper healing and reduce the risk of the hernia coming back. It is also important to attend all follow-up appointments with your doctor to monitor your recovery progress.

Suitable For

Patients who are typically recommended hernia repair are those who have symptoms of a hernia, such as discomfort, pain, or a visible bulge in the affected area. In the case of paraesophageal hernia, patients may also experience symptoms such as difficulty swallowing, chest pain, or regurgitation of food.

Patients who are at high risk of complications from a hernia, such as blockages or tears, are also recommended for hernia repair. This includes patients with large hernias or those with symptoms that are worsening over time.

In the case of paraesophageal hernia specifically, patients who have been diagnosed with this condition and are experiencing symptoms are often recommended for hernia repair. This is because paraesophageal hernias can lead to serious complications if left untreated.

Overall, patients who are experiencing symptoms of a hernia or who are at risk of complications from a hernia are typically recommended for hernia repair. It is important for these patients to consult with a healthcare provider to determine the best course of treatment for their specific situation.

Timeline

Before hernia repair:

  • Patient may experience symptoms such as abdominal pain, bloating, difficulty swallowing, and heartburn
  • Patient may undergo diagnostic tests such as an endoscopy or imaging studies to confirm the presence of a hernia
  • Patient may be advised by their healthcare provider to undergo hernia repair surgery to prevent complications

After hernia repair:

  • Patient undergoes hernia repair surgery, which may involve using techniques such as anterior gastropexy to secure the stomach and prevent the hernia from reoccurring
  • Patient may experience post-operative pain, swelling, and discomfort
  • Patient is advised to follow post-operative care instructions, including restrictions on physical activity and dietary changes
  • Patient undergoes follow-up appointments with their healthcare provider to monitor their recovery and assess the success of the hernia repair.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hernia repair, specifically regarding gastropexy for paraesophageal hernia, include:

  1. What are the potential risks and complications associated with gastropexy for treating paraesophageal hernia?
  2. How long is the recovery period after undergoing gastropexy surgery?
  3. What is the success rate of gastropexy in preventing the recurrence of paraesophageal hernia?
  4. Are there any lifestyle changes or dietary restrictions I should follow after gastropexy surgery?
  5. How experienced are you in performing gastropexy procedures for paraesophageal hernia?
  6. Are there any alternative treatments or procedures available for paraesophageal hernia, and how do they compare to gastropexy?
  7. What is the likelihood of needing additional surgeries or procedures in the future if I choose gastropexy for my paraesophageal hernia?
  8. Can you explain the potential long-term effects or outcomes of choosing gastropexy for treating paraesophageal hernia?
  9. How soon after symptoms appear should I consider undergoing gastropexy surgery for paraesophageal hernia?
  10. Are there any specific pre-operative preparations I should be aware of before undergoing gastropexy surgery for paraesophageal hernia?

Reference

Authors: Kamran H, Shafiq H, Mansoor M, Minhas UE, Tahira S, Shahid S, Khan F. Journal: Surgeon. 2025 Feb;23(1):e21-e31. doi: 10.1016/j.surge.2024.10.001. Epub 2024 Oct 16. PMID: 39419710