Background: Paraesophageal hernia (PEH) repair via laparoscopy has evolved significantly over the past decades, aiming to reduce the symptoms of recurrence and gastroesophageal reflux disease (GERD). This study evaluates short- and long-term outcomes of laparoscopic PEH repair with emphasis on surgical technique evolution, mesh use, fundoplication, and anterior gastropexy. Methods: We retrospectively analyzed 341 consecutive patients who underwent laparoscopic repair for primary or recurrent PEH from March 2003 to March 2024. Surgical techniques varied over time, especially concerning mesh type, fundoplication strategy, and use of gastropexy. Main outcomes were recurrence of PEH or GERD. Secondary endpoints included intra- and postoperative complications. Results: Of 341 patients, 91% received mesh reinforcement and 80% underwent fundoplication. Recurrence occurred in 66.7% of patients treated with suture-only hiatoplasty versus 3.9% with mesh reinforcement ( P < .001). GERD recurrence was significantly lower in patients with Nissen-Rossetti (0%) and Toupet (7.5%) fundoplication compared to no fundoplication (40.0%) or suture-only hiatoplasty (66.7%). Anterior gastropexy, introduced systematically since 2020, was associated with improved anatomical stability. Early postoperative complications occurred in 8% of patients. The most common was left pleural opening (66.7%), followed by hemopericardium (11.1%), gas bloat syndrome (11.1%), and one case of splenic injury. Two patients experienced gastric wall perforation after fundoplication, requiring reoperation. Overall mortality was 0.6%. Conclusion: Tension-free hiatoplasty reinforced with mesh is essential to minimize recurrence. The routine use of anterior gastropexy, particularly in large hernias, further improves anatomical stability. Tailored fundoplication and proper functional assessment complete an effective, individualized surgical approach.
Delcarro et al. (2026) studied this question.