Gastropexy may reduce symptomatic recurrence in paraesophageal hernia repair: a Scandinavian retrospective multicenter study

Paraesophageal hernia (PEH) repair is challenging, with high recurrence rates reported. Evidence suggests that anterior gastropexy may reduce the recurrence rate, but real-world data are lacking. We performed a retrospective multicenter study of adults undergoing PEH repair (2018-2023) at four Scandinavian centers. The primary outcome was a computed tomograpy (CT) verified recurrence defined radiologically as a ≥20 mm herniation above the diaphragm. Propensity score matching balanced patients with and without anterior gastropexy. Outcomes and predictors were analyzed using matched comparisons and Cox proportional hazards regression. A total of 395 patients underwent primary PEH repair during the study period. The median age was 70 (range 63-76) years, and the median follow-up was 1.8 (0.8-3.3) years. 297 (75%) patients received a gastropexy as part of the procedure, while 98 (25%) patients did not. The group without gastropexy had a significantly higher rate of recurrence, 33 out of 98 patients (34%) compared with the gastropexy group, 45 out of 297 patients (15%, P < 0.001). After propensity score matching and adjustment for confounding factors, the risk of recurrence remained higher for patients who did not receive gastropexy (HR: 2.5, 95% CI: 1.3-4.9; P = 0.007). Anterior gastropexy was associated with a significantly lower risk of recurrence following PEH repair. These findings indicate that this component of the surgical procedure might improve long-term outcomes.