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SAGES 2026 Annual Meeting Emerging Technology Session
March 25-28, 2026 | Tampa, FL, USA
P582
Early experience with a novel, reinforced approach to anterior gastropexy in laparoscopic paraesophageal hernia repair
Poster Presenter
Authors
Sydney Selznick, Daniel French, Alexander Ednie, James Ellsmere
Affiliations
Part of Topic
Foregut
Background
Recent evidence supports anterior gastropexy as an adjunct during paraesophageal hernia repair to reduce recurrence
We have developed a novel anterior gastropexy technique based on an understanding of soft tissue biomechanics wherein a reinforced gastric staple line buttresses the gastropexy sutures, reducing the chance of suture pull through, and improving the durability of the gastropexy.
This project summarizes our local experience with soft tissue anchored anterior gastropexy during paraesophageal hernia repair since its inception in 2019
Methods
Single-centre retrospective case series
All hiatal hernia repairs performed by the MIS Foregut group January 2020 - December 2025
Exclusion criteria: open cases; recurrent hiatal hernia; prior or concomitant gastric operations; concomitant procedures; emergency repairs; use of hiatal mesh: and concomitant inflammatory bowel disease
Primary outcome: hiatal hernia recurrence within one year.
Soft Tissue Reinforced Anterior Gastropexy Technique
Cruroplasty is completed using permanent, braided suture.
A small stapled wedge gastrectomy is performed along the anterior stomach using a bioabsorbable staple line reinforcement.
Two gastropexy sutures are placed, one at either end of the reinforced staple line.
Staple line is fixated to the anterior abdominal wall with transfascial sutures using a suture passer.
This anterior gastropexy technique can be utilized alone or in conjunction with fundoplication.
Discussion
Gastropexy during paraesophageal hernia repair was first described by Boerema and Germs in 1955
Traditionally utilized as a damage control maneuver; over time, gastropexy has become more commonly utilized in elective repairs to restore normal anatomy and to reduce recurrence risk
We observed that standard suture gastropexy or PEG-based gastropexy had often failed at the time of revisional surgery, likely from tissue cut-through
Load distribution over a longer segment of tissue reduces localized stress and risk of tissue cut-through. Our method uses just two gastropexy sutures but the applied load is distributed across all titanium staples within the suture line
An endoGIA staple line typically contains approximately 90 staples, meaning each individual staple bears roughly 1/90th of the total gastropexy load
In our series of patients, there were no major complications and no returns to the OR in the immediate postoperative period
The soft tissue reinforced anterior gastropexy did not seem to add any additional risk in the patients we have reviewed thus far.
Conclusion
Soft-tissue anchored gastropexy during paraesophageal hernia repair is a safe technique showing promising results in terms of durability, likely due to the distribution of tension along multiple staples, preventing suture migration and tissue cut-through.