Anterior Gastropexy Added to Paraesophageal Hernia Repair May Reduce Recurrence

Petro CC, Ellis RC, Maskal SM, et al. Anterior Gastropexy for Paraesophageal Hernia Repair: A Randomized Clinical Trial. JAMA Surg. 2025;160(3):247-255.

Schlottmann F, Herbella FAM, Patti MG. Management of paraesophageal hernia-still a controversial topic . JAMA Surg. 2025;160(3):255-256.

Paraesophageal hernia is a variant of hiatal hernia that occurs when a portion of the stomach herniates through the esophageal hiatus alongside the esophagus. These hernias may cause severe reflux symptoms and post-prandial chest pain. Life-threatening complications, including ischemic injury, perforation, and obstruction also occur.

Minimally invasive surgical hernia repair is the recommended treatment for this condition, but hernia recurrence rates of more than 50% have been reported. Data cited by the authors suggested that suturing of the stomach to the anterior abdominal wall—anterior gastropexy—after hernia repair could reduce recurrences.

This randomized prospective study (n = 240) compared patients who had anterior gastropexy with patients who had hernia repair alone. The data analysis showed that hernia recurrence at 1 year of follow up was 15% in patients who had gastropexy and 36% in patients with hernia repair without gastropexy.

The authors recommended that anterior gastropexy be added to paraesophageal hernia repair procedures.

In the editorial that accompanied the article, Schlottmann and coauthors emphasized the importance of adding fundoplication to the hernia repair procedure to reduce risk of postoperative reflux symptoms. They also noted that a significant proportion of hernia recurrences are diagnosed after 1 year of follow up; more long-term data will be needed to confirm the value of anterior gastropexy.