Laparoscopic repair of giant paraesophageal hernia: are there factors associated with anatomic recurrence? Michael Antiporda 1 • Benjamin Veenstra 2 • Chloe Jackson 1 • Pujan Kandel 1 • C. Daniel Smith 3 • Steven P. Bowers 1 Received: 24 March 2017 / Accepted: 14 July 2017 Ó Springer Science+Business Media, LLC 2017 Abstract Background Repair of giant paraesophageal hernia (PEH) is associated with a favorably high rate of symptom improvement; however, rates of recurrence by objective measures remain high. Herein we analyze our experience with laparoscopic giant PEH repair to determine what factors if any can predict anatomic recurrence. Methods We prospectively collected data on PEH char- acteristics, variations in operative techniques, and surgeon factors for 595 patients undergoing laparoscopic PEH repair from 2008 to 2015. Upper GI study was performed at 6 months postoperatively and selectively thereafter—any supra-diaphragmatic stomach was considered hiatal hernia recurrence. Exclusion criteria included revisional operation (22.4%), size \5 cm (17.6%), inadequate follow-up (17.8%), and confounding concurrent operations (6.9%). Inclusion criteria were met by 202 patients (31% male, median age 71 years, and median BMI 28.7). Results At a median follow-up of 6 months (IQR 6–12), overall anatomic recurrence rate was 34.2%. Symptom recurrence rate was 9.9% and revisional operation was required in ten patients (4.9%). Neither patient demo- graphics nor PEH characteristics (size, presence of Cameron erosions, esophagitis, or Barrett’s) correlated with anatomic recurrence. Technical factors at operation (mobilized intra-abdominal length of esophagus, Collis gastroplasty, number of anterior/posterior stitches, use of crural buttress, use of pledgeted or mattress sutures, or gastrostomy) were also not correlated with recurrence. Regarding surgeon factors, annual volume of fewer than ten cases per year was associated with increased risk of anatomic failure (54 vs 33%, P = 0.02). Multivariate analysis identified surgeon experience (\10 cases per year) as an independent factor associated with early hiatal hernia recurrence (OR 3.7, 95% CI 1.34–10.9). Conclusions Laparoscopic repair of giant PEH is associ- ated with high anatomic recurrence rate but excellent symptom control. PEH characteristics and technical oper- ative variables do not appear to significantly affect rates of recurrence. In contrast, surgeon volume does appear to contribute significantly to durability of repair. Keywords Paraesophageal hernia repair Á Laparoscopy Á Recurrence Á Outcomes Paraesophageal hernias (PEH) constitute 5–10% of hiatal hernias, which occur in roughly 10% of the general pop- ulation [1]. Approximately half of paraesophageal hernias are symptomatic, causing pyrosis, regurgitation, epigastric or chest pain, dysphagia, and postprandial fullness. They may also be associated with extra-esophageal symptoms such as chronic cough and aspiration. One-third may be associated with anemia secondary to Cameron erosions [1]. Rarely, they may present acutely with organoaxial or mesenteroaxial volvulus which can progress to strangula- tion, gastric necrosis, and perforation. Early studies ascri- bed a mortality rate of up to 30% when intervention is Presented at the SAGES 2017 Annual Meeting, March 22–25, 2017, Houston, Texas. & Steven P. Bowers bowers.steven@mayo.edu 1 Department of Surgery, Mayo Clinic in Florida, Davis 3 North, 4500 San Pablo Road, Jacksonville, FL 32224, USA 2 Department of Surgery, Rush University Medical Center, Chicago, IL, USA 3 Piedmont Hospital, Atlanta, GA, USA 123 Surg Endosc DOI 10.1007/s00464-017-5770-z and Other Interventional Techniques