• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Giant Paraesophageal Hernia Repair without Antireflux Procedure as management of GERD

Giant Paraesophageal Hernia Repair without Antireflux Procedure as management of GERD

Lauren McCormack, MD, Carl Westcott, MD. Wake Forest

Introduction: Fundoplication at the time of giant paraesophageal hernia repair is controversial. The proposed advantages are better reflux control and lower recurrence. Disadvantages include fundoplication specific complications, might be unnecessary and may not decrease recurrence. We retrospectively reviewed giant paraesophageal hernia repairs (PEH) with two point gastropexy in the fundus and body, and no antireflux procedure. Data collected is postoperative GERD symptoms, postoperative Proton Pump inhibitors (PPIs) therapy and recurrence. 

Methods: A retrospective review of patients who underwent repair of giant PEH from 2012 to December of 2016. Giant was defined as a hernia with 50% or more of the stomach above the diaphragm.  Follow up consisted of upper GI (UGI) study one year postoperatively and reflux symptom questionnaire. Patients were followed every 4 months in the surgery clinic and a PPI wean was initiated at the second postoperative visit.  The primary outcome we evaluated was discontinuation of PPIs.  In addition, we utilized a standardized reflux scale and recurrence rates collected. Chi-Squared was used for statistical analysis.

Results: 69 patients underwent giant PEH repair as described, 13 (18.8%) were previously repaired.  Average age was 68 years, and 54 of the patients were female.  58 patients (84%) reported preoperative PPI usage and 86% (59) of patients reported preoperative GERD symptoms.  Seven patients were lost to follow up before the third postoperative visit.  42 (61%) patients received a one year UGI follow up and average follow up is 344 days post-operatively.  The recurrence rate was 15.9% (11 patients), 3 (4.3%) required repeat repair.

25 of 58 patients were off PPI therapy postoperatively (chi 20.16, p<001).  33 patients continued single dosage PPI postoperatively. 20 patients reported full symptom relief on single dosage PPI.  Total of 44 of 61 patients reported improvement in symptoms postoperatively regardless of PPI use (Chi 33.13, p <0.001).  9 of 59 patients had continued to report some GERD symptoms despite PPI therapy. No patients reported worsening GERD symptoms.  The most common postoperative complaint was dysphagia, occurring in 17 (24%) patients.

Conclusion: Antireflux procedure in the setting of giant PEH repair proved extraneous in most these patients (44 of 69).  Its possible that 9 of 69 would benefit from a fundoplication because of GERD despite medication after operation. The conundrum is beneficiaries cannot be identified preoperatively and exposing all giant PEH patients to the risk of dysphagia (11% to 15%), gas bloat (40%) and fundoplication failure (30%) seems unwarranted.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87108

Program Number: P407

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

54

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals