Use of gastropexy for paraesophageal hernias—a narrative review

Abstract

Background and Objective: Gastropexy involves surgical fixation of the stomach within the abdomen to prevent re-herniation or volvulus in patients presenting with giant paraesophageal hernias. Multiple different techniques have been used and key ones will be reviewed here. This review focuses on the utility of gastropexy as a potential operative strategy to manage specific subsets of patients presenting with paraesophageal hernia and provides some historical context around the development of this technique in their operative management. While it is important to understand that hiatal hernia repair with creation of a gastrofundoplication has emerged as the current recommended standard of treatment in these patients, the use of gastropexy, while traditionally reserved in the emergent setting for patients presenting with signs of acute gastric volvulus, may be evolving as an option for patients undergoing elective or semi-elective repair of large paraesophageal hernias. Methods: A literature search was performed to identify pertinent articles involving the use of gastropexy in the surgical treatment of paraesophageal hernias. PubMed was the main source of articles. Available data in English regarding both historical and current indications and methods was assessed for the purposes of this narrative review. Key Content and Findings: The technique and utilization of gastropexy with paraesophageal hernias has evolved over the years. There is some promising, but not robust data regarding long-term outcomes and quality of life following gastropexy in select patients. Conclusions: While gastrofundoplication remains a standard approach, in patients presenting with predominantly obstructive signs and symptoms, and a history consistent with minimal or well-controlled reflux disease, gastropexy may provide significant clinical benefit while diminishing less desirable sequelae or side effects of traditional anti-reflux procedures.