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Practice Guideline
. 2024 Sep;38(9):4765-4775.
doi: 10.1007/s00464-024-11092-3. Epub 2024 Jul 30.

SAGES guidelines for the surgical treatment of hiatal hernias

Shaun Daly  1 , Sunjay S Kumar  2 , Amelia T Collings  3 , Nader M Hanna  4 , Yagnik K Pandya  5 , James Kurtz  6 , Keshav Kooragayala  7 , Meghan W Barber  8 , Mykola Paranyak  9 , Marina Kurian  10 , Jeffrey Chiu  11 , Mohammed T Ansari  12 , Bethany J Slater  13 , Geoffrey P Kohn  14
Affiliations
Practice Guideline

SAGES guidelines for the surgical treatment of hiatal hernias

Shaun Daly et al. Surg Endosc. 2024 Sep.

Abstract

Background: Hiatal hernia (HH) is a common condition. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians, patients, and others in decisions regarding the treatment of HH.

Methods: Systematic reviews were conducted for four key questions regarding the treatment of HH in adults: surgical treatment of asymptomatic HH versus surveillance; use of mesh versus no mesh; performing a fundoplication versus no fundoplication; and Roux-en-Y gastric bypass (RYGB) versus redo fundoplication for recurrent HH. Evidence-based recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluations methodology by subject experts. When the evidence was insufficient to base recommendations on, expert opinion was utilized instead. Recommendations for future research were also proposed.

Results: The panel provided one conditional recommendation and two expert opinions for adults with HH. The panel suggested routinely performing a fundoplication in the repair of HH, though this was based on low certainty evidence. There was insufficient evidence to make evidence-based recommendations regarding surgical repair of asymptomatic HH or conversion to RYGB in recurrent HH, and therefore, only expert opinions were offered. The panel suggested that select asymptomatic patients may be offered surgical repair, with criteria outlined. Similarly, it suggested that conversion to RYGB for management of recurrent HH may be appropriate in certain patients and again described criteria. The evidence for the routine use of mesh in HH repair was equivocal and the panel deferred making a recommendation.

Conclusions: These recommendations should provide guidance regarding surgical decision-making in the treatment of HH and highlight the importance of shared decision-making and consideration of patient values to optimize outcomes. Pursuing the identified research needs will improve the evidence base and may allow for stronger recommendations in future evidence-based guidelines for the treatment of HH.

Keywords: Fundoplication; Hiatal hernia; Mesh; Recurrent hiatal hernia; Redo fundoplication; Roux-en-Y gastric bypass.

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References

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