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

John R. Stringham, Jennifer V. Phillips, Timothy L. McMurry, Drew L. Lambert, David R. Jones, James M. Isbell, Christine L. Lau, Benjamin D. Kozower

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7 Scopus citations

Abstract

Objective 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 1-year follow-up. Methods Patients undergoing elective GPEH repair between 2011 and 2014 were enrolled prospectively. Postoperatively, patients were evaluated at 1 month and 1 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 postoperatively with the use of a validated questionnaire. Results One-hundred six patients were enrolled. The majority of GPEH repairs were performed laparoscopically (80.2%), and 7.5% were redo repairs. At 1-year follow-up, 63.4% of patients were symptom free, and radiographic recurrence was 32.7%. Recurrence rate was 18.8% with standard definition (>2 cm of stomach above the diaphragm). Quality of life scores at 1 year were significantly better after operative repair, even in patients with radiographic recurrence (7.0 vs 22.5 all patients, 13.0 vs 22.5 with recurrence; P <.001). Patients with small radiographic recurrences have similar satisfaction and symptom severity to patients with >2 cm recurrences. Conclusions GPEH repair can be performed with low operative mortality and morbidity. The rate of recurrence at 1 year depends on the definition used. Patient satisfaction and symptom severity are similar between patients with radiographic and greater than 2 cm 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.

Original languageEnglish
Pages (from-to)743-751
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume154
Issue number2
DOIs
StatePublished - Aug 2017

Keywords

  • laparoscopy
  • long-term outcomes
  • outcomes research
  • paraesophageal hernia
  • recurrence

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    Stringham, J. R., Phillips, J. V., McMurry, T. L., Lambert, D. L., Jones, D. R., Isbell, J. M., Lau, C. L., & Kozower, B. D. (2017). Prospective study of giant paraesophageal hernia repair with 1-year follow-up. Journal of Thoracic and Cardiovascular Surgery, 154(2), 743-751. https://doi.org/10.1016/j.jtcvs.2017.03.138