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Contemporary management of paraesophaegeal hernias: establishing a European expert consensus

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Abstract

Background

The surgical treatment of paraesophageal hernias remains a challenge due to the lack of consensus regarding principles of operative treatment. The objectives of this study were to achieve consensus on key topics through expert opinion using a Delphi methodology.

Methods

A Delphi survey combined with a face-to-face meeting was conducted. A panel of European experts in foregut surgery from high-volume centres generated items in the first survey round. In subsequent rounds, the panel rated agreement with statements on a 5-point Likert-type scale. Internal consistency (consensus) was predefined as Cronbach’s α > .80. Items that >70 % of the panel either rated as irrelevant/unimportant, or relevant/important were selected as consensus items, while topics that did not reach this cut-off were termed “undecided/controversial”.

Results

Three survey rounds were completed: 19 experts from 10 countries completed round one, 18 continued through rounds two and three. Internal consistency was high in rounds two and three (α > .90). Fifty-eight additional/revised items derived from comments and free-text entries were included in round three. In total, 118 items were rated; consensus agreement was achieved for 70 of these. Examples of consensus topics are the relevance of the disease profile for assessing surgical urgency and complexity, the role of clinical history as the mainstay of patient follow-up, indications for revision surgery, and training and credentialing recommendations. Topics with the most “undecided/controversial” items were follow-up, postoperative care and surgical technique.

Conclusions

This Delphi study achieved expert consensus on key topics in the operative management of paraesophageal hernias, providing an overview of the current opinion among European foregut surgeons. Moreover, areas with substantial variability in opinions were identified reflecting the current lack of empirical evidence and opportunities for future research.

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Acknowledgments

The authors would like to acknowledge Dr. Stavros Antoniou for lending his expertise to the discussion round during the face-to face meeting.

Disclosures

Teodor Grantcharov and Esther Bonrath have no conflict of interest to disclose.

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Authors and Affiliations

  1. University of Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada

    E. M. Bonrath & T. P. Grantcharov

  2. University of Copenhagen, Copenhagen, Denmark

    T. P. Grantcharov

Authors
  1. E. M. Bonrath
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  2. T. P. Grantcharov
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Corresponding author

Correspondence to E. M. Bonrath.

Additional information

On Behalf of the European Paraesophageal Hernia Advisory Board.

Appendix

Appendix

Members of the European Paraesophageal Hernia Advisory Board: Ivo Broeders, Bernard Dallemagne, Giovanni Dapri, Jesper Durup, Peter Funch-Jensen, Frank Granderath, Teodor Grantcharov, Bengt Hakansson, Thomas Hüttl, Lisbeth Hvolris, Oliver Koch, Mario Morino, Giovanni Pallabazzer, Rudolph Pointner, Jari Rasanen, Marlies Schijven, Eduard Targarona, Anders Thorell.

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Bonrath, E.M., Grantcharov, T.P. Contemporary management of paraesophaegeal hernias: establishing a European expert consensus. Surg Endosc 29, 2180–2195 (2015). https://doi.org/10.1007/s00464-014-3918-7

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