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EAES Multidisciplinary Rapid Guideline: systematic review, meta-analysis, GRADE assessment and evidence-informed recommendations on the surgical management of paraesophageal hernias

Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

New evidence has emerged since latest guidelines on the management of paraesophageal hernia, and guideline development methodology has evolved. Members of the European Association for Endoscopic Surgery have prioritized the management of paraesophageal hernia to be addressed by pertinent recommendations.

Objective

To develop evidence-informed clinical practice recommendations on paraesophageal hernias, through evidence synthesis and a structured evidence-to-decision framework by an interdisciplinary panel of stakeholders.

Methods

We performed three systematic reviews, and we summarized and appraised the certainty of the evidence using the GRADE methodology. A panel of general and upper gastrointestinal surgeons, gastroenterologists and a patient advocate discussed the evidence in the context of benefits and harms, the certainty of the evidence, acceptability, feasibility, equity, cost and use of resources, moderated by a Guidelines International Network-certified master guideline developer and chair. We developed the recommendations in a consensus meeting, followed by a modified Delphi survey.

Results

The panel suggests surgery over conservative management for asymptomatic/minimally symptomatic paraesophageal hernias (conditional recommendation), and recommends conservative management over surgery for asymptomatic/minimally symptomatic paraesophageal hernias in frail patients (strong recommendation). Further, the panel suggests mesh over sutures for hiatal closure in paraesophageal hernia repair, fundoplication over gastropexy in elective paraesophageal hernia repair, and gastropexy over fundoplication in patients who have cardiopulmonary instability and require emergency paraesophageal hernia repair (conditional recommendation). A strong recommendation means that the proposed course of action is appropriate for the vast majority of patients. A conditional recommendation means that most patients would opt for the proposed course of action, and joint decision-making of the surgeon and the patient is required. Accompanying evidence summaries and evidence-to-decision frameworks should be read when using the recommendations. This guideline applies to adult patients with moderate to large paraesophageal hernias type II to IV with at least 50% of the stomach herniated to the thoracic cavity. The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/j7q7Gn.

Conclusion

An interdisciplinary panel provides recommendations on key topics on the management of paraesophageal hernias using highest methodological standards and following a transparent process.

Guideline registration number

PREPARE-2023CN018.

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References

  1. Landreneau RJ, Del Pinto M, Santos R (2005) Management of paraesophageal hernias. Surg Clin North Am 85:411–432

    Article  PubMed  Google Scholar 

  2. Aye RW, Blitz M, Farivar A et al (2011) Repair of symptomatic giant paraesophageal hernias in elderly (>70 years) patients results in improved quality of life. J Gastrointest Surg 15:389–396

    Article  PubMed  Google Scholar 

  3. Patel NM, Puri A, Sounderajah V et al (2021) Quality of life and symptom assessment in paraesophageal hernias: a systematic review of reporting standards. Dis Esophagus 34:1–10

    Article  Google Scholar 

  4. Carrot PW, Hong J, Kuppusamy M et al (2012) Repair of giant paraesophageal hernia routinely produces improvement in respiratory function. J Thorac Cardiovasc Surg 143:398–404

    Article  Google Scholar 

  5. El Khoury R, Ramirez M, Hungness ES et al (2015) Symptom relief after laparoscopic paraesophageal hernia repair without mesh. J Gastrointest Surg 19:1938–1942

    Article  PubMed  Google Scholar 

  6. Kohn GP, Price RR, DeMeester SR et al (2013) Guidelines for the management of hiatal hernia. Surg Endosc 27:4409–4428

    Article  PubMed  Google Scholar 

  7. Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236:492–501

    Article  PubMed  PubMed Central  Google Scholar 

  8. Buenaventura PO, Christie NA, Fernando HC et al (2002) Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg 74:1909–1915

    Article  PubMed  Google Scholar 

  9. Tam V, Luketich JD, Levy R et al (2014) Mesh cruroplasty in laparoscopic repair of paraesophageal hernias is not associated with better long-term outcomes compared to primary repair. Gastroenterology 146:S1062

    Article  Google Scholar 

  10. Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137(6):649–652. https://doi.org/10.1001/archsurg.137.6.649

    Article  PubMed  Google Scholar 

  11. Fuchs KH, Babic B, Breithaupt W et al (2014) EAES recommendations for the management of gastroesophageal reflux disease. Surg Endosc 28:1753–1773

    Article  PubMed  Google Scholar 

  12. European Association for Endoscopic Surgery and other Interventional Techniques (2022) Outcome of the EAES poll to prioritize topics for future guidelines. https://eaes.eu/wp-content/uploads/2022/05/2022-05-09-poll.pdf. Accessed 13 July 2022

  13. Schünemann H, Brożek J, Guyatt G, Oxman A (2013) GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. https://gdt.gradepro.org/app/handbook/handbook.html. Accessed 1 Jan 2022

  14. AGREE-S: AGREE II extension for guidelines on surgical interventions (2021) https://agree-s.org/. Accessed 1 Jan 2022

  15. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines (2011) Clinical practice guidelines we can trust. Washington, DC: National Academies Press

  16. Qaseem A, Forland F, Macbeth F, Ollenschläger G, Phillips S, van der Wees P; Board of Trustees of the Guidelines International Network (2012) Guidelines International Network: toward international standards for clinical practice guidelines. Ann Intern Med 156(7):525–531. https://doi.org/10.7326/0003-4819-156-7-201204030-00009

    Article  Google Scholar 

  17. Garritty C, Gartlehner G, Nussbaumer-Streit B, King VJ, Hamel C, Kamel C, Affengruber L, Stevens A (2021) Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews. J Clin Epidemiol 130:13–22. https://doi.org/10.1016/j.jclinepi.2020.10.007

    Article  PubMed  Google Scholar 

  18. (2022) Appendix files for EAES Multidisciplinary Rapid Guideline: systematic review, meta-analysis, GRADE assessment and evidence-informed recommendations on the surgical management of paraesophageal hernias. http://bit.ly/3r68WKm. Accessed 4 July 2023

  19. Schünemann HJ, Al-Ansary LA, Forland F, Kersten S, Komulainen J, Kopp IB, Macbeth F, Phillips SM, Robbins C, van der Wees P, Qaseem A, Board of Trustees of the Guidelines International Network (2015) Guidelines International Network: principles for disclosure of interests and management of conflicts in guidelines. Ann Intern Med 163(7):548–553. https://doi.org/10.7326/M14-1885

    Article  PubMed  Google Scholar 

  20. European Association for Endoscopic Surgery and other Interventional Techniques (2023) Guideline protocol: EAES multidisciplinary rapid guideline: systematic review, meta-analysis, GRADE assessment and evidence-informed recommendations on the surgical management of paraesophageal hernias. https://eaes.eu/wp-content/uploads/2023/01/Protocol-draft-HIHE.pdf. Accessed 4 July 2023

  21. Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, Alderson P, Glasziou P, Falck-Ytter Y, Schünemann HJ (2011) GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 64(4):395–400. https://doi.org/10.1016/j.jclinepi.2010.09.012

    Article  PubMed  Google Scholar 

  22. Hultcrantz M, Rind D, Akl EA, Treweek S, Mustafa RA, Iorio A, Alper BS, Meerpohl JJ, Murad MH, Ansari MT, Katikireddi SV, Östlund P, Tranæus S, Christensen R, Gartlehner G, Brozek J, Izcovich A, Schünemann H, Guyatt G (2017) The GRADE Working Group clarifies the construct of certainty of evidence. J Clin Epidemiol 87:4–13. https://doi.org/10.1016/j.jclinepi.2017.05.006

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tsujimoto Y, Fujii T, Tsutsumi Y, Kataoka Y, Tajika A, Okada Y, Carrasco-Labra A, Devji T, Wang Y, Guyatt GH, Furukawa TA (2022) Minimal important changes in standard deviation units are highly variable and no universally applicable value can be determined. J Clin Epidemiol 145:92–100. https://doi.org/10.1016/j.jclinepi.2022.01.017

    Article  PubMed  Google Scholar 

  24. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan—a web and mobile app for systematic reviews. Syst Rev 5(1):210. https://doi.org/10.1186/s13643-016-0384-4

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 28(366):l4898. https://doi.org/10.1136/bmj.l4898

    Article  Google Scholar 

  26. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 12(355):i4919. https://doi.org/10.1136/bmj.i4919

    Article  Google Scholar 

  27. McGuinness LA, Higgins JPT (2021) Risk-of-bias visualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12(1):55–61. https://doi.org/10.1002/jrsm.1411

    Article  PubMed  Google Scholar 

  28. Borenstein M, Hedges LV, Higgins JP, Rothstein HR (2010) A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Method 1:97–111. https://doi.org/10.1002/jrsm.12

    Article  Google Scholar 

  29. Nikolakopoulou A, Mavridis D, Salanti G (2014) How to interpret meta-analysis models: fixed effect and random effects meta-analyses. Evid Based Ment Health 17(2):64. https://doi.org/10.1136/eb-2014-101794

    Article  PubMed  Google Scholar 

  30. Watson DI, Thompson SK, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG (2015) Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial. Ann Surg 261(2):282–289. https://doi.org/10.1097/SLA.0000000000000842

    Article  PubMed  Google Scholar 

  31. Balduzzi S, Rücker G, Schwarzer G (2019) How to perform a meta-analysis with R: a practical tutorial. Evid-Based Ment Health 22:153–160

  32. R Core Team (2022) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. https://www.R-project.org/

  33. Veroniki AA, Jackson D, Viechtbauer W, Bender R, Bowden J, Knapp G, Kuss O, Higgins JP, Langan D, Salanti G (2016) Methods to estimate the between-study variance and its uncertainty in meta-analysis. Res Synth Methods 7(1):55–79. https://doi.org/10.1002/jrsm.1164

    Article  Google Scholar 

  34. Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629. https://doi.org/10.1136/bmj.315.7109.629

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Schünemann H, Brożek J, Guyatt G, Oxman A (2013) GRADE handbook: 5 quality of evidence. https://gdt.gradepro.org/app/handbook/handbook.html#h.9rdbelsnu4iy. Accessed 1 Jan 2022

  36. Pai M, Yeung CHT, Akl EA, Darzi A, Hillis C, Legault K, Meerpohl JJ, Santesso N, Taruscio D, Verhovsek M, Schünemann HJ, Iorio A (2019) Strategies for eliciting and synthesizing evidence for guidelines in rare diseases. BMC Med Res Methodol 19(1):67. https://doi.org/10.1186/s12874-019-0713-0

    Article  PubMed  PubMed Central  Google Scholar 

  37. Oude Nijhuis RAB, Hoek MV, Schuitenmaker JM, Schijven MP, Draaisma WA, Smout AJPM, Bredenoord AJ (2020) The natural course of giant paraesophageal hernia and long-term outcomes following conservative management. United Eur Gastroenterol J 8(10):1163–1173. https://doi.org/10.1177/2050640620953754

    Article  Google Scholar 

  38. Sihvo EI, Salo JA, Räsänen JV, Rantanen TK (2009) Fatal complications of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg 137(2):419–424. https://doi.org/10.1016/j.jtcvs.2008.05.042

    Article  Google Scholar 

  39. Analatos A, Håkanson BS, Lundell L, Lindblad M, Thorell A (2020) Tension-free mesh versus suture-alone cruroplasty in antireflux surgery: a randomized, double-blind clinical trial. Br J Surg 107(13):1731–1740. https://doi.org/10.1002/bjs.11917

    Article  CAS  PubMed  Google Scholar 

  40. Oor JE, Roks DJ, Koetje JH, Broeders JA, van Westreenen HL, Nieuwenhuijs VB, Hazebroek EJ (2018) Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh. Surg Endosc 32(11):4579–4589. https://doi.org/10.1007/s00464-018-6211-3

    Article  PubMed  Google Scholar 

  41. Ilyashenko VV, Grubnyk VV, Grubnik VV (2018) Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair. Surg Endosc 32(8):3592–3598. https://doi.org/10.1007/s00464-018-6087-2

    Article  CAS  PubMed  Google Scholar 

  42. Koetje JH, Irvine T, Thompson SK, Devitt PG, Woods SD, Aly A, Jamieson GG, Watson DI (2015) Quality of life following repair of large hiatal hernia is improved but not influenced by use of mesh: results from a randomized controlled trial. World J Surg 39(6):1465–1473. https://doi.org/10.1007/s00268-015-2970-3

    Article  PubMed  Google Scholar 

  43. Watson DI, Thompson SK, Devitt PG, Aly A, Irvine T, Woods SD, Gan S, Game PA, Jamieson GG (2020) Five year follow-up of a randomized controlled trial of laparoscopic repair of very large hiatus hernia with sutures versus absorbable versus nonabsorbable mesh. Ann Surg 272(2):241–247. https://doi.org/10.1097/SLA.0000000000003734

    Article  PubMed  Google Scholar 

  44. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244(4):481–490. https://doi.org/10.1097/01.sla.0000237759.42831.03

    Article  PubMed  PubMed Central  Google Scholar 

  45. Oelschlager BK, Petersen RP, Brunt LM, Soper NJ, Sheppard BC, Mitsumori L, Rohrmann C, Swanstrom LL, Pellegrini CA (2012) Laparoscopic paraesophageal hernia repair: defining long-term clinical and anatomic outcomes. J Gastrointest Surg 16(3):453–459. https://doi.org/10.1007/s11605-011-1743-z

    Article  PubMed  Google Scholar 

  46. Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213(4):461–468. https://doi.org/10.1016/j.jamcollsurg.2011.05.017

    Article  PubMed  Google Scholar 

  47. Granderath FA, Kamolz T, Schweiger UM, Pointner R (2006) Impact of laparoscopic Nissen fundoplication with prosthetic hiatal closure on esophageal body motility: results of a prospective randomized trial. Arch Surg 141(7):625–632. https://doi.org/10.1001/archsurg.141.7.625 (Erratum in: Arch Surg 2007;142(6):579)

    Article  PubMed  Google Scholar 

  48. Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140(1):40–48. https://doi.org/10.1001/archsurg.140.1.40

    Article  PubMed  Google Scholar 

  49. Frantzides CT, Richards CG, Carlson MA (1999) Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene. Surg Endosc 13(9):906–908. https://doi.org/10.1007/s004649901131

    Article  CAS  PubMed  Google Scholar 

  50. Carlson MA, Richards CG, Frantzides CT (1999) Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy. Dig Surg 16(5):407–410. https://doi.org/10.1159/000018756

    Article  CAS  PubMed  Google Scholar 

  51. Dara V, Croo A, Peirsman A, Pattyn P (2019) Necessity of fundoplication and mesh in the repair of the different types of paraesophageal hernia. Acta Gastroenterol Belg 82(2):251–256

    CAS  PubMed  Google Scholar 

  52. Levy G, Aye RW, Farivar AS, Louie BE (2017) A combined Nissen plus hill hybrid repair for paraesophageal hernia improves clinical outcomes and reduces long-term recurrences compared with laparoscopic Nissen alone. J Gastrointest Surg 21(1):121–125. https://doi.org/10.1007/s11605-016-3225-9

    Article  PubMed  Google Scholar 

  53. Pallabazzer G, Santi S, Parise P, Solito B, Giusti P, Rossi M (2011) Giant hiatal hernias: direct hiatus closure has an acceptable recurrence rate. Updates Surg 63(2):75–81. https://doi.org/10.1007/s13304-011-0066-7

    Article  PubMed  Google Scholar 

  54. Boushey RP, Moloo H, Burpee S, Schlachta CM, Poulin EC, Haggar F, Trottier DC, Mamazza J (2008) Laparoscopic repair of paraesophageal hernias: a Canadian experience. Can J Surg 51(5):355–360

    PubMed  PubMed Central  Google Scholar 

  55. McLean TR, Haller CC, Lowry S (2006) The need for flexibility in the operative management of type III paraesophageal hernias. Am J Surg 192(5):e32–e36. https://doi.org/10.1016/j.amjsurg.2006.08.030

    Article  PubMed  Google Scholar 

  56. Wu JS, Dunnegan DL, Soper NJ (1999) Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair. Surg Endosc 13(5):497–502. https://doi.org/10.1007/s004649901021

    Article  CAS  Google Scholar 

  57. Leese T, Perdikis G (1998) Management of patients with giant paraesophageal hernia. Dis Esophagus 11(3):177–180. https://doi.org/10.1093/dote/11.3.177

    Article  CAS  PubMed  Google Scholar 

  58. Oddsdottir M, Franco AL, Laycock WS, Waring JP, Hunter JG (1995) Laparoscopic repair of paraesophageal hernia. New access, old technique. Surg Endosc 9(2):164–168. https://doi.org/10.1007/BF00191959

    Article  CAS  Google Scholar 

  59. Larusson HJ, Zingg U, Hahnloser D, Delport K, Seifert B, Oertli D (2009) Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity. World J Surg 33(5):980–985. https://doi.org/10.1007/s00268-009-9958-9

    Article  PubMed  Google Scholar 

  60. Andujar JJ, Papasavas PK, Birdas T, Robke J, Raftopoulos Y, Gagné DJ, Caushaj PF, Landreneau RJ, Keenan RJ (2004) Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc 18(3):444–447. https://doi.org/10.1007/s00464-003-8823-4

    Article  CAS  PubMed  Google Scholar 

  61. Müller-Stich BP, Achtstätter V, Diener MK, Gondan M, Warschkow R, Marra F, Zerz A, Gutt CN, Büchler MW, Linke GR (2015) Repair of paraesophageal hiatal hernias—is a fundoplication needed? A randomized controlled pilot trial. J Am Coll Surg 221(2):602–610. https://doi.org/10.1016/j.jamcollsurg.2015.03.003

    Article  PubMed  Google Scholar 

  62. Jung JJ, Naimark DM, Behman R, Grantcharov TP (2018) Approach to asymptomatic paraesophageal hernia: watchful waiting or elective laparoscopic hernia repair? Surg Endosc 32(2):864–871. https://doi.org/10.1007/s00464-017-5755-y

    Article  PubMed  Google Scholar 

  63. Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236(4):492–500. https://doi.org/10.1097/00000658-200210000-00012 (discussion 500–501)

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors acknowledge the contribution of Prof. Peter Grimminger for his contribution in prioritizing outcomes and defining minimal important differences.

Disclaimer

This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g., surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g., surgical nurses, dieticians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by health care authorities (e.g., regional and national authorities, health care institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point in time. The information in the guideline should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time the guideline is developed and when it is published or read. The guideline is not continually updated and may not reflect the most recent evidence. The guideline addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This guideline does not mandate any particular course of medical care. Further, the guideline is not intended to substitute the independent professional judgment of the treating provider, as the guideline does not necessarily account for individual variation among patients. Even if evidence on a topic suggests a specific diagnostic and/or treatment action, users and especially health professionals may need to decide against the suggested or recommended action in view of circumstances related to patient values, preferences, co-morbidities and disease characteristics; available human, financial and material resources; and healthcare infrastructures. EAES provides this guideline on an “as is” basis, and makes no warranty, express or implied, regarding the guideline.

Funding

This project was funded by the European Association for Endoscopic Surgery. The funding body had no influence on the development of this rapid guideline or its protocol. There is no grant number linked to this research.

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Sheraz R. Markar, Nainika Menon, Nadia Guidozzi, Katerina-Maria Kontouli, Dimitrios Mavridis, Alexandros Andreou, Felix Berlth, Luigi Bonavina, Alfred Cushieri, Lana Fourie, James Gossage, Caroline Gronnier, Eric J. Hazebroek, Sheila Krishnadath, Donald E. Low, Mimi McCord, Roos E. Pouw, David I. Watson, Francesco Maria Carrano, Monica Ortenzi and Stavros A. Antoniou declare no direct conflicts of interest related to this work. Indirect conflicts of external advisors were documented and managed as per Guidelines International Network Standards. Detailed conflict of interest statements of all contributors can be found in http://bit.ly/3r68WKm. A patient version of this guideline is available in Supplementary File 1.

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Markar, S.R., Menon, N., Guidozzi, N. et al. EAES Multidisciplinary Rapid Guideline: systematic review, meta-analysis, GRADE assessment and evidence-informed recommendations on the surgical management of paraesophageal hernias. Surg Endosc 37, 9013–9029 (2023). https://doi.org/10.1007/s00464-023-10511-1

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