Background: Paraoesophageal hernias (PEH) are associated with a high complication rate and often occur in elderly and fragile patients. Surgical gastropexy without fundoplication, in which the stomach is attached to the anterior abdominal wall is an accepted alternative procedure and considered as low-risk intervention. However, outcome and functional results are hardly described in literature. Our study aims to evaluate short-term outcomes and the long-term quality of life of patients who underwent a gastropexy as treatment for PEH. Methods: Single center cohort analysis of all consecutive patients who underwent hiatal repair and gastropexy for PEH without fundoplication from 2015 to 2021. Postoperative outcomes and functional results were retrospectively collected via chart review of postoperative routine follow-up. Reflux symptoms developed postoperatively were reported using the validated quality of life questionnaire: GERD-Health Related Quality of Life Qestionnaire (GERD-HRQL). Postoperative complications were reported according to Clavien-Dindo complication grade.
Results: Thirty patients (median age: 72 years (65-80)) were included, 40% classified as ASA III. Main PEH symptoms were reflux (63%), abdominal/thoracic pain (47%), pyrosis (33%), anorexia (30%), and food blockage (26%). Twenty-six laparoscopies were performed (86%). Major complications (III-IVb) occurred in 9 patients (30%). Seven patients (23%) had PEH recurrence, all re-operated, performing a new gastropexy. Median follow-up was 38 (17-50) months, one patient was lost. Twenty-two patients (75%) reported symptoms resolution with median GERD-HRQL scale of 4 (1-6). 72% (n=21) reported operation satisfaction. GERD- HRQL was comparable between patients who were re-operated for recurrence and others: 5 (2-19) versus 3 (0-6), p=0.100.
Conclusion: Gastropexy without fundoplication was performed by laparoscopy in most cases with acceptable complications rates. Two-thirds of patients reported symptoms resolution, and long-term quality-of-live associated to reflux symptoms is good. Although the rate of PEH recurrence requiring a new re-intervention remained increased (23%), it does not seem to affect long-term functional results.