HIATAL MESH SHAPE: A MULTICENTER STUDY EVALUATING ITS EFFECT ON HERNIA RECURRENCE
Dear colleague,
The optimal technique for crural repair during minimally invasive paraesophageal hernia surgery remains a subject of considerable debate. Recent studies suggest that mesh-buttressed cruroplasty offers significant advantages over simple suture techniques by reducing recurrence rates. Traditionally, outcomes for mesh-reinforced cruroplasty have focused on posterior mesh placement at the hiatus. However, recent evidence indicates that most recurrences occur anteriorly, prompting surgeons to employ keyhole or circumferential mesh configurations to reinforce the anterior and anterolateral aspects of the hiatus.
With the present retrospective multicenter study, we aim to include patients with symptomatic primary paraesophageal hernia (Skinner classification II-IV) who underwent elective minimally invasive repair (laparoscopic and robotic) with mesh placement from January 2015 to June 2025. Other hiatal hernia (specifically axial/sliding hernia type I), emergencies and recurrent paraesophageal hernia are not within the scope of this project. Data will be collected for all mesh types, including both non-resorbable and resorbable, with subgroup analyses conducted based on mesh shape (posterior vs. keyhole/circumferential), mesh material, and surgical approach (laparoscopic vs. robotic).
The primary objective of this study will be to assess the outcomes of posterior mesh placement versus keyhole/circular-shaped mesh with respect to hiatal hernia recurrence rates, and to investigate the potential impact of mesh configuration on these rates. Secondary analyses will focus on evaluating the effects of mesh material and surgical technique.
This research is conducted under the patronage of the European Foregut Society (EFS) that we thank for the great support. We plan to publish our results in a peer-reviewed journal. Collaborative authorship may be extended to a maximum of three participants per center. All collaborators commit to sharing patient information, which will be handled confidentially and anonymized to ensure privacy. Data collection is scheduled to commence in January 2026, with completion anticipated by April 15th, 2026.
We invite you to participate in this multicenter study. For information and to join the study please contact
Very best regard and thank you for your precious cooperation
Principal investigators
Alberto Aiolfi MD FACS FEBS (UGI)
Filippo Bistagnino MD
Davide Bona MD FACS
Luigi Bonavina MD FACS (Hon)
Hiatal Hernia Survey (C. Gutschow)
Despite growing scientific evidence regarding many surgical-technical aspects, the treatment of paraesophageal hiatal hernia remains an extremely controversial topic.
The goal of this initiative is to establish treatment recommendations among international experts in the field via a 2- or 3-step-Delphi survey. We are grateful for the official support of the recently founded European Foregut Society.
In order to narrow down the subject, our survey strictly refers to elective surgery for primary hiatal hernia with paraesophageal component (Skinner classification Types II-VI). Other hiatal hernia types (specifically axial/sliding hernia Type I), emergencies and recurrences are not within the scope of this project.
This actual Round I of the Delphi survey will take about 30 minutes to complete. Please be aware, you may discontinue the survey at any time and continue where you left off if using the same computer and browser.
We are planning to publish our results in a peer-reviewed journal. Participants that complete all rounds will be granted group authorship, which counts as a full co-authorship and is retrievable via PubMed.
To keep momentum going, we would be grateful if you could complete this questionnaire within the next two weeks.
Very best regards and thank you for your cooperation
