Impact of Diaphragmatic Relaxing Incision on One-Year Recurrence After Paraesophageal Hernia Repair
Alexandros Tsoposidis, Srdjan Kostic, Lars Lundell, Ville Wallenius, Hans Axelsson, Anders Thorell, Bengt Håkanson, Marcus Reuterwall HanssonIntroduction:
Paraesophageal hernia (PEH) repair is associated with high recurrence rates, and various reinforcement techniques have failed to improve repair durability. In this study, the effect of a left-sided diaphragmatic relaxing incision added to standard crural repair was evaluated.
Methods:
In this double-blind, dual-center, randomized clinical trial, patients undergoing PEH repair between August 2019 and August 2023 were randomized to either standard crural repair (control) or crural repair with a left-sided diaphragmatic relaxing incision covered by a synthetic mesh. All patients underwent total fundoplication. The primary endpoint was computed tomography–verified PEH recurrence at 12 months. Secondary outcomes included perioperative course, reflux, dysphagia, abdominal symptoms, and quality of life (QoL) at 3, 6, and 12 months.
Results:
Seventy-six patients with comparable baseline characteristics were randomized (38 per group). One patient in each group died within 90 days of surgery. At 12 months, radiological recurrence rates were 65.7% in the control group and 55.3% in the intervention group (
Discussion:
Radiological recurrence rates remain high after laparoscopic PEH repair. The addition of a left-sided diaphragmatic relaxing incision to standard PEH repair did not result in a clinically relevant reduction in one-year radiological recurrence risk. Our findings do not support routine implementation of this technique.