Anterior Gastropexy for MIS-PEHR
Trial question
What is the role of anterior gastropexy in patients who underwent minimally invasive paraesophageal hernia repair?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
84.0% female
16.0% male
N = 240
240 patients (201 female, 39 male).
Inclusion criteria: adult patients with paraesophageal hernia eligible for minimally invasive repair.
Key exclusion criteria: recurrent paraesophageal hernias; prior or concomitant gastric operations; emergency repair; need for hiatal mesh during the repair.
Interventions
N=119 anterior gastropexy (transfascial fixation of the anterior body of the stomach to the abdominal wall after paraesophageal hernia repair).
N=121 no gastropexy (no gastropexy performed after paraesophageal hernia repair).
Primary outcome
Paraesophageal hernia recurrence > 2 cm on radiographic imaging at 1 year or reoperation
15%
36%
36.0 %
27.0 %
18.0 %
9.0 %
0.0 %
Anterior
gastropexy
No
gastropexy
Significant
decrease ▼
NNT = 4
Significant decrease in paraesophageal hernia recurrence > 2 cm on radiographic imaging at 1 year or reoperation (15% vs. 36%; RD 0.21, 95% CI 0.09 to 0.33).
Secondary outcomes
No significant difference in reoperation for recurrence at 1 year (2.5% vs. 8.2%; ARD -5.7, 95% CI -11.46 to 0.06).
No significant difference in patient satisfaction at 1 year (75.7% vs. 70.5%; AD 5.2%, 95% CI -6.25 to 16.65).
No significant difference in patient satisfaction at 30 days (76.9% vs. 77.2%; ARD -0.3, 95% CI -42.67 to 42.07).
Safety outcomes
No significant difference in intraoperative complications.
Conclusion
In adult patients with paraesophageal hernia eligible for minimally invasive repair, anterior gastropexy was superior to no gastropexy with respect to paraesophageal hernia recurrence > 2 cm on radiographic imaging at 1 year or reoperation.
Reference
Clayton C Petro, Ryan C Ellis, Sara M Maskal et al. Anterior Gastropexy for Paraesophageal Hernia Repair: A Randomized Clinical Trial. JAMA Surg. 2025 Mar 1;160(3):247-255.
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