Prospective study of giant paraesophageal hernia repair with 1-year follow-up

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d7198461e194">Objective</h5> <p id="P1">Evaluating giant paraesophageal hernia (GPEH) repair requires long-term follow-up. GPEH repair can have associated high recurrence rates, yet this incidence depends on how recurrence is defined. Our objective was to prospectively evaluate patients undergoing GPEH repair with one-year follow-up. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d7198461e199">Methods</h5> <p id="P2">Patients undergoing elective GPEH repair between 2011 and 2014 were prospectively enrolled. Postoperatively, patients were evaluated at one-month and one-year. Radiographic recurrence was evaluated by barium swallow and defined as a gastroesophageal junction located above the hiatus. Quality of life was evaluated pre- and post-operatively using a validated questionnaire. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d7198461e204">Results</h5> <p id="P3">One-hundred six patients were enrolled. The majority of GPEH repairs were performed laparoscopically (80.2%) and 7.5% were redo repairs. At one-year follow-up, 63.4% of patients were symptom free and radiographic recurrence was 32.7%. Recurrence rate was 18.8% with standard definition (&gt; 2cm of stomach above the diaphragm). Quality of life scores at one year were significantly better following operative repair, even in patients with radiographic recurrence (7.0 vs. 22.5 all patients, 13.0 vs 22.5 with recurrence (P&lt;0.001). Patients with small radiographic recurrences have similar satisfaction and symptom severity to patients with &gt; 2 cm recurrences. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d7198461e209">Conclusions</h5> <p id="P4">GPEH repair can be performed with low operative mortality and morbidity. The rate of recurrence at one year depends on the definition used. Patient satisfaction and symptom severity are similar between patients with radiographic and &gt;2cm hernia recurrences. Longer follow-up and critical assessment of our results are needed to understand the true impact of this procedure and better inform perioperative decision making. </p> </div><p id="P5"> <b>Central Message:</b> Small paraesophageal hernia recurrences at one-year follow-up have similar satisfaction and symptom scores as those with larger recurrences. </p><p id="P6">Central Picture:</p><p id="P7"> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/73acbb63-715d-460d-a5b8-dc314660fdab/PubMedCentral/image/nihms896208u1.jpg"/> </div> </p><p id="P8">Barium swallow study of a giant paraesophageal hernia.</p>