Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

Aims: There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods: We conducted a 2-round, 33-qu...

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Autores: Gerdes, Stephan, Schoppmann, Sebastian F., Bonavina, Luigi, Boyle, Nicholas, Müller-Stich, Beat P., Gutschow, Christian A., Hiatus Hernia Delphi Collaborative Group
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Recursos:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/59601
Acesso em linha:http://hdl.handle.net/10230/59601
http://dx.doi.org/10.1007/s00464-023-09933-8
Access Level:acceso abierto
Palavra-chave:Delphi survey
Fundoplication
Hiatus hernia
Mesh
Paraesophageal hernia
Surgical technique
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spelling Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensusGerdes, StephanSchoppmann, Sebastian F.Bonavina, LuigiBoyle, NicholasMüller-Stich, Beat P.Gutschow, Christian A.Hiatus Hernia Delphi Collaborative GroupDelphi surveyFundoplicationHiatus herniaMeshParaesophageal herniaSurgical techniqueAims: There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods: We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as "recommended" or "discouraged" if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled "acceptable" (neither recommended nor discouraged). Results: Seventy-two surgeons with a median (IQR) experience of 23 (14-30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15-36) and 40 (28-60) pHH-surgeries, respectively. After Delphi round 2, "recommended" strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified "discouraged" strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were "acceptable". Conclusions: This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.Springer202420242023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/59601http://dx.doi.org/10.1007/s00464-023-09933-8reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésSurg Endosc. 2023 Jun;37(6):4555-65© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/596012026-06-12T07:21:37Z
dc.title.none.fl_str_mv Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
title Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
spellingShingle Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
Gerdes, Stephan
Delphi survey
Fundoplication
Hiatus hernia
Mesh
Paraesophageal hernia
Surgical technique
title_short Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
title_full Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
title_fullStr Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
title_full_unstemmed Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
title_sort Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus
dc.creator.none.fl_str_mv Gerdes, Stephan
Schoppmann, Sebastian F.
Bonavina, Luigi
Boyle, Nicholas
Müller-Stich, Beat P.
Gutschow, Christian A.
Hiatus Hernia Delphi Collaborative Group
author Gerdes, Stephan
author_facet Gerdes, Stephan
Schoppmann, Sebastian F.
Bonavina, Luigi
Boyle, Nicholas
Müller-Stich, Beat P.
Gutschow, Christian A.
Hiatus Hernia Delphi Collaborative Group
author_role author
author2 Schoppmann, Sebastian F.
Bonavina, Luigi
Boyle, Nicholas
Müller-Stich, Beat P.
Gutschow, Christian A.
Hiatus Hernia Delphi Collaborative Group
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Delphi survey
Fundoplication
Hiatus hernia
Mesh
Paraesophageal hernia
Surgical technique
topic Delphi survey
Fundoplication
Hiatus hernia
Mesh
Paraesophageal hernia
Surgical technique
description Aims: There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods: We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as "recommended" or "discouraged" if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled "acceptable" (neither recommended nor discouraged). Results: Seventy-two surgeons with a median (IQR) experience of 23 (14-30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15-36) and 40 (28-60) pHH-surgeries, respectively. After Delphi round 2, "recommended" strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified "discouraged" strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were "acceptable". Conclusions: This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.
publishDate 2023
dc.date.none.fl_str_mv 2023
2024
2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/59601
http://dx.doi.org/10.1007/s00464-023-09933-8
url http://hdl.handle.net/10230/59601
http://dx.doi.org/10.1007/s00464-023-09933-8
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Surg Endosc. 2023 Jun;37(6):4555-65
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Springer
publisher.none.fl_str_mv Springer
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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