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J Thorac Cardiovasc Surg. 2017 Aug;154(2):743-751. doi: 10.1016/j.jtcvs.2017.03.138. Epub 2017 Apr 11.

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

Author information

1
Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Va.
2
Division of Public Health Sciences, University of Virginia Health Sciences Center, Charlottesville, Va.
3
Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, Va.
4
Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
5
Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo. Electronic address: kozowerb@wudosis.wustl.edu.

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.

KEYWORDS:

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

PMID:
28502624
PMCID:
PMC5659114
DOI:
10.1016/j.jtcvs.2017.03.138
[Indexed for MEDLINE]
Free PMC Article

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