Bibliographic record
Abstract
Central MessageRecurrence rates after repair of paraesophageal hernia continues to be high. Surgeons should adhere to all components of the repair and perform each with great attention to detail.See Article page 497. Recurrence rates after repair of paraesophageal hernia continues to be high. Surgeons should adhere to all components of the repair and perform each with great attention to detail. See Article page 497. Repair of paraesophageal hernia has evolved greatly since its earliest description in 1919.1Stylopoulos N. Rattner D.W. The history of hiatal hernia surgery: from Bowditch to laparoscopy.Ann Surg. 2005; 241: 185-193Crossref PubMed Scopus (108) Google Scholar Open thoracic approaches have made way to minimally invasive techniques by laparoscopy; however, recurrence rates have been high, reportedly up to 60%.2Laliberte A.S. Louie B.E. Short-term and long-term outcomes of paraesophageal hernia repair.Thorac Surg Clin. 2019; 29: 405-414Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Although most recurrences are radiographic, with rates of revision surgery being much lower, this high rate indicates that the surgical community still needs to improve. The current Video Atlas article provided to us by Alicuben and colleagues3Alicuben E.T. Luketich J.D. Levy R.M. Laparoscopic repair of giant paraesophageal hernia.J Thorac Cardiovasc Surg Tech. 2021; 10: 497-502Scopus (3) Google Scholar is a detailed description of the operative technique used at the University of Pittsburgh Medical Center to achieve a successful and durable repair of paraesophageal hernias. The components of the repair need not be restated here, as they are clearly explained and demonstrated by the authors. Needless to say, each of these components are of vital importance to the repair and should be meticulously performed, without short cuts or compromise. The surgeons at the University of Pittsburgh Medical Center have long been leaders in the field of minimally invasive foregut surgery. Luketich and colleagues4Luketich J.D. Nason K.S. Christie N.A. Pennathur A. Jobe B.A. Landreneau R.J. et al.Outcomes after a decade of laparoscopic giant paraesophageal hernia repair.J Thorac Cardiovasc Surg. 2010; 139: 395-404Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar had previously published their results of giant paraesophageal hernia repair by laparoscopy, reporting a radiographic recurrence rate of 15.7% and a reoperative rate for recurrence of 3.2%. These results are comparable with the often-quoted benchmark set by Maziak and colleagues5Maziak D.E. Todd T.R. Pearson F.G. Massive hiatus hernia: evaluation and surgical management.J Thorac Cardiovasc Surg. 1998; 115: 53-60Abstract Full Text Full Text PDF PubMed Scopus (208) Google Scholar at the University of Toronto of 2.2% with transthoracic repair. It is unlikely that the “Holy Grail” of zero recurrence after paraoesophageal hernia repair will ever be attained; the hiatus is a dynamic region under constant stress and strain, but the recurrence rates still appear to be high. It is imperative to show the medical community that we can do much better; surgeons should honestly evaluate their recurrence rates and, if high, improve their technique. This Video Atlas article by Alicuben and colleagues3Alicuben E.T. Luketich J.D. Levy R.M. Laparoscopic repair of giant paraesophageal hernia.J Thorac Cardiovasc Surg Tech. 2021; 10: 497-502Scopus (3) Google Scholar provides the perfect start; it is indeed a must-read (must-view) for surgeons of all levels who seek to tackle the repair of such a complex region. As a final thought, it has been more than a decade since Luketich and colleagues4Luketich J.D. Nason K.S. Christie N.A. Pennathur A. Jobe B.A. Landreneau R.J. et al.Outcomes after a decade of laparoscopic giant paraesophageal hernia repair.J Thorac Cardiovasc Surg. 2010; 139: 395-404Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar first published their outstanding results with laparoscopic repair of giant paraesophageal hernia. As the authors have shown, the development of new techniques is of paramount importance toward reducing morbidity for our patients. Hopefully, the authors continue to review and share their results for the more recent cohort to elucidate a promising trend for decreased recurrence rates. Laparoscopic repair of giant paraesophageal herniaJTCVS TechniquesVol. 10PreviewFeature Editor's Introduction—Secondary to its intricacies and complexities, “benign esophageal surgery” is often considered its own surgical field, composed primarily of antireflux surgery, esophageal motility surgery, and surgery of the esophageal hiatus. Giant paraesophageal hernias are hiatal hernias in which greater than one third of the stomach is intrathoracic and their repair is arguably one of the most complex “benign esophageal” procedures. They are large (by definition), can contain multiple abdominal viscera, and may necessitate additional esophageal lengthening procedures. Full-Text PDF Open Access
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".