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Abstract：
There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology.
We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as \"recommended\" or \"discouraged\" if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled \"acceptable\" (neither recommended nor discouraged).
Seventy-two surgeons with a median (IQR) experience of 23 (14-30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15-36) and 40 (28-60) pHH-surgeries, respectively. After Delphi round 2, \"recommended\" strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified \"discouraged\" strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were \"acceptable\".
This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.
We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as \"recommended\" or \"discouraged\" if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled \"acceptable\" (neither recommended nor discouraged).
Seventy-two surgeons with a median (IQR) experience of 23 (14-30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15-36) and 40 (28-60) pHH-surgeries, respectively. After Delphi round 2, \"recommended\" strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified \"discouraged\" strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were \"acceptable\".
This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.
摘要：
目的：关于食管裂孔旁疝（pHH）患者的最佳管理存在相当大的争议。这项调查旨在确定推荐的工作策略，手术治疗,术后随访采用德尔菲法。
方法：我们进行了2轮，33个问题，基于网络的Delphi围手术期管理调查(术前检查，外科手术和随访)的非修订版，在具有上消化道专业知识的欧洲外科医生中选择pHH。在5点Likert量表上对反应进行评分，并使用描述性统计进行分析。如果参与者之间的正面或负面一致性>75％，则将问卷中的项目定义为“推荐”或“不鼓励”。一致性水平较低的物品被标记为“可接受”(既不建议也不鼓励)。
结果：来自17个欧洲国家的72位中位（IQR）经验为23年（14-30年）的外科医生参加了（应答率60％）。年度中位数（IQR）个人和机构病例量为25（15-36）和40（28-60）pHH手术，分别。在Delphi第2轮之后，定义了术前检查（内窥镜检查）的“推荐”策略，手术指征（典型症状和/或慢性贫血），外科解剖（疝囊解剖和切除术，保护迷走神经，小腿筋膜和胸膜,心脏后脂肪瘤切除术）和重建（单针后路缝合术，食管下括约肌扩张术（尼森或Toupet），术后随访（造影）。此外,我们确定了术前检查的“不鼓励”策略（内窥镜检查），和外科重建(缝合缝合，仅使用网孔进行无张力裂孔修复)。相比之下,问卷中的许多项目，包括网格增强的大多数细节(适应症，材料,形状,placement,和固定技术）是“可接受的”。
结论：这项跨国的欧洲德尔菲调查代表了第一个由专家主导的过程，以确定建议的pHH管理策略。我们的工作可能有助于临床实践指导诊断过程，提高程序的一致性和标准化，并促进合作研究。
方法：我们进行了2轮，
结果：来自17个欧洲国家的72位中位（IQR）经验为23年（14-30年）的外科医生参加了（应答率60％）。
结论：这项跨国的欧洲德尔菲调查代表了第一个由专家主导的过程，以确定建议的pHH管理策略。
