{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:10:06Z","timestamp":1786975806561,"version":"build-2736575974"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"\n Importance<\/jats:title>\n Paraesophageal hernias can cause severe limitations in quality of life and life-threatening complications. Even though minimally invasive paraesophageal hernia repair (MIS-PEHR) is safe and effective, anatomic recurrence rates remain notoriously high. Retrospective data suggest that suturing the stomach to the anterior abdominal wall after repair\u2014an anterior gastropexy\u2014may reduce recurrence, but this adjunct is currently not the standard of care.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether anterior gastropexy reduces 1-year recurrence after MIS-PEHR.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This registry-based randomized clinical trial was conducted by 10 surgeons at 3 academic hospitals within the Cleveland Clinic Enterprise. Between June 26, 2019, and July 24, 2023, 348 patients were assessed for eligibility, and 240 patients were enrolled and randomized. Statistical analysis was performed from January to March 2024.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Enrolled patients were randomized to and received either an anterior gastropexy (n\u2009=\u2009119) or no anterior gastropexy (n\u2009=\u2009121).<\/jats:p>\n <\/jats:sec>\n \n Main Outcome<\/jats:title>\n The primary outcome was recurrence as determined by reherniation of the stomach greater than 2 cm above the diaphragm on routine imaging at 1 year or reoperation. Secondary outcomes included quality of life as measured by the Gastroesophageal Reflux Health-Related Quality of Life survey, additional foregut symptom questionnaire, and patient satisfaction at 30 days and 1 year.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 240 patients were randomized to either anterior gastropexy (n\u2009=\u2009119; 104 [97%] women; median [IQR] age, 70 [64-75] years) or no anterior gastropexy (n\u2009=\u2009121; 97 [80%] women; median [IQR] age, 68 [62-73] years) at the end of their MIS-PEHR. At 1 year, 188 patients (78%) had completed follow-up. By intention-to-treat analysis, 1-year recurrence was significantly lower in patients who received an anterior gastropexy (15% vs 36%; risk difference, 0.21 [95% CI, 0.09-0.33]), which remained significant after risk-adjusted regression analysis (hazard ratio, 0.38 [95% CI, 0.23-0.60]). Of 13 reoperations (5.4%) for recurrence in the first year, 3 (2.5%) were in the anterior gastropexy group and 10 (8.2%) were in the no-gastropexy group (\n P<\/jats:italic>\n \u2009=\u2009.052). Two patients (1.7%) had their anterior gastropexy sutures removed for pain. There were no significant differences in quality-of-life outcomes at 30 days and 1 year between treatment groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This randomized clinical trial found that the addition of an anterior gastropexy to MIS-PEHR is superior to no gastropexy in regard to reducing 1-year paraesophageal hernia recurrence. These results suggest that an anterior gastropexy should be routinely used in the context of minimally invasive paraesophageal hernia repair.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04007952<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2024.5788","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T11:03:51Z","timestamp":1734951831000},"page":"247","source":"Crossref","is-referenced-by-count":24,"title":["Anterior Gastropexy for Paraesophageal Hernia Repair"],"prefix":"10.1001","volume":"160","author":[{"given":"Clayton C.","family":"Petro","sequence":"first","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan C.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara M.","family":"Maskal","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam J.","family":"Zolin","sequence":"additional","affiliation":[{"name":"Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adele","family":"Costanzo","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas R. A.","family":"Beffa","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Krpata","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diya","family":"Alaedeen","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Digestive Disease and Surgery Institute, Fairview Hospital, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajita S.","family":"Prabhu","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin T.","family":"Miller","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin F.","family":"Baier","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Digestive Disease and Surgery Institute, Fairview Hospital, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisan","family":"Fathalizadeh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Rosen","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"5","key":"soi240094r2","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1001\/jamasurg.2015.25","article-title":"Long-term quality of life and risk factors for recurrence after laparoscopic repair of paraesophageal hernia.","volume":"150","author":"Lidor","year":"2015","journal-title":"JAMA Surg"},{"issue":"1","key":"soi240094r3","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.athoracsur.2023.01.017","article-title":"The impact of age and need for emergent surgery in paraesophageal hernia repair outcomes.","volume":"116","author":"Wong","year":"2023","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"soi240094r4","first-page":"267","article-title":"Elective laparoscopic paraesophageal hernia repair leads to an increase in life expectancy over watchful waiting in asymptomatic patients: an updated Markov analysis.","volume":"279","author":"DeMeester","year":"2024","journal-title":"Ann Surg"},{"issue":"1","key":"soi240094r5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/SLA.0000000000004913","article-title":"Laparoscopic paraesophageal hernia repair: to mesh or not to mesh. systematic review and meta-analysis.","volume":"275","author":"Angeramo","year":"2022","journal-title":"Ann Surg"},{"issue":"12","key":"soi240094r6","doi-asserted-by":"publisher","first-page":"1910","DOI":"10.1007\/s11605-010-1308-6","article-title":"Laparoscopic repair of large hiatal hernia without prosthetic reinforcement: late results and relevance of anterior gastropexy.","volume":"14","author":"Poncet","year":"2010","journal-title":"J Gastrointest Surg"},{"issue":"7","key":"soi240094r7","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1007\/s00464-002-8765-2","article-title":"Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair.","volume":"17","author":"Ponsky","year":"2003","journal-title":"Surg Endosc"},{"issue":"1","key":"soi240094r8","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1186\/s13063-022-06571-8","article-title":"Comparing anterior gastropexy to no anterior gastropexy for paraesophageal hernia repair: a study protocol for a randomized control trial.","volume":"23","author":"Blake","year":"2022","journal-title":"Trials"},{"issue":"4","key":"soi240094r9","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1097\/01.sla.0000237759.42831.03","article-title":"Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial.","volume":"244","author":"Oelschlager","year":"2006","journal-title":"Ann Surg"},{"issue":"2","key":"soi240094r10","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1111\/j.1442-2050.2007.00658.x","article-title":"The development of the GERD-HRQL symptom severity instrument.","volume":"20","author":"Velanovich","year":"2007","journal-title":"Dis Esophagus"},{"issue":"2","key":"soi240094r11","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.amjsurg.2019.03.025","article-title":"A multi-center, prospective clinical trial of a hepatic derived porcine surgical mesh for the laparoscopic repair of symptomatic paraesophageal hernias.","volume":"218","author":"Rosen","year":"2019","journal-title":"Am J Surg"},{"issue":"2","key":"soi240094r12","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"issue":"5","key":"soi240094r13","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1097\/SLA.0000000000000948","article-title":"The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials.","volume":"260","author":"Slankamenac","year":"2014","journal-title":"Ann Surg"},{"issue":"2","key":"soi240094r14","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.jtcvs.2009.10.005","article-title":"Outcomes after a decade of laparoscopic giant paraesophageal hernia repair.","volume":"139","author":"Luketich","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"soi240094r15","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/S1091-255X(02)00151-8","article-title":"Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients.","volume":"7","author":"Diaz","year":"2003","journal-title":"J Gastrointest Surg"},{"issue":"4","key":"soi240094r16","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1016\/S0003-4975(00)01229-7","article-title":"Laparoscopic management of giant paraesophageal herniation.","volume":"71","author":"Wiechmann","year":"2001","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"soi240094r17","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1097\/SLA.0b013e3181ff44c0","article-title":"Laparoscopic repair of paraesophageal hernia. long-term follow-up reveals good clinical outcome despite high radiological recurrence rate.","volume":"253","author":"Dallemagne","year":"2011","journal-title":"Ann Surg"},{"issue":"5","key":"soi240094r18","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1007\/s00464-001-8194-7","article-title":"Long-term outcome of laparoscopic repair of paraesophageal hernia.","volume":"16","author":"Mattar","year":"2002","journal-title":"Surg Endosc"},{"issue":"5","key":"soi240094r19","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1016\/S1072-7515(00)00260-X","article-title":"Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate.","volume":"190","author":"Hashemi","year":"2000","journal-title":"J Am Coll Surg"},{"issue":"5","key":"soi240094r20","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/j.jamcollsurg.2011.01.060","article-title":"Laparoscopic versus open repair of paraesophageal hernia: the second decade.","volume":"212","author":"Zehetner","year":"2011","journal-title":"J Am Coll Surg"},{"issue":"4","key":"soi240094r21","first-page":"456","article-title":"Metaanalysis of recurrence after laparoscopic repair of paraesophageal hernia.","volume":"11","author":"Rathore","year":"2007","journal-title":"JSLS"},{"key":"soi240094r1","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/978-3-031-39199-6_34","volume-title":"The SAGES Manual of Physiologic Evaluation of Foregut Diseases","author":"Kriley","year":"2023"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2828586\/jamasurgery_petro_2024_oi_240094_1741298271.70412.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T11:01:32Z","timestamp":1741777292000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2828586"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2024.5788","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}