2023欧洲共识：食管旁裂孔疝的管理

Surgical Endoscopyhttp5/doi.org/10.1007/s00464-023-09933-8场ORIGINAL ARTICLEManagement of paraesophageal hiatus hernia:recommendationsfollowing a European expert Delphi consensusStephan Gerdes'.Sebastian F.Schoppmann2.Luigi Bonavina3.Nicholas Boyle4.Beat P.Muller-Stich5.Christian A.Gutschow'.the Hiatus Hernia Delphi Collaborative GroupReceived:20 July 2022/Accepted:5 February 2023©The Author(s)2023AbstractAims There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia(pHH).This survey aims at identifying recommended strategies for work-up,surgical therapy,and postoperative follow-up usingDelphi methodology.Methods We conducted a 2-round,33-question,web-based Delphi survey on perioperative management(preoperative work-up,surgical procedure and follow-up)of non-revisional,elective pHH among European surgeons with expertise in upper-GI.Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics.Items from the questionnaire weredefined as"recommended"or "discouraged"if positive or negative concordance among participants was>75%.Items withlower concordance levels were labelled"acceptable"(neither recommended nor discouraged).Results Seventy-two surgeons with a median (IQR)experience of 23 (14-30)years from 17 European countries participated(response rate 60%).The annual median (IQR)individual and institutional caseload was 25(15-36)and 40(28-60)pHH-surgeries,respectively.After Delphi round 2,"recommended"strategies were defined for preoperative work-up (endoscopy),indication for surgery (typical symptoms and/or chronic anemia),surgical dissection (hernia sac dissection and resection,preservation of the vagal nerves,crural fascia and pleura,resection of retrocardial lipoma)and reconstruction(posteriorcrurorrhaphy with single stitches,lower esophageal sphincter augmentation (Nissen or Toupet),and postoperative follow-up(contrast radiography).In addition,we identified"discouraged"strategies for preoperative work-up (endosonography),andsurgical reconstruction (crurorrhaphy with running sutures,tension-free hiatus repair with mesh only).In contrast,manyitems from the questionnaire including most details of mesh augmentation (indication,material,shape,placement,and fixa-tion technique)were“acceptable'”.Conclusions This multinational European Delphi survey represents the first expert-led process to identify recommendedstrategies for the management of pHH.Our work may be useful in clinical practice to guide the diagnostic process,increaseprocedural consistency and standardization,and to foster collaborative research.Keywords Hiatus hernia.Paraesophageal hernia.Surgical technique.Mesh.Fundoplication.Delphi surveyOptimal treatment of paraesophageal hiatus hernia (pHH)complementary sphincter augmentation and the diagnosisremains a highly debated topic in upper-gastrointestinaland treatment of short esophagus.(UGI)surgery.Numerous aspects regarding both the diag-Based on our own clinic