Background: Although laparoscopic repair of paraesophageal hernias (LPH) results in effective symptomatic relief, there is concern regarding the rate of hiatal hernia recurrence; especially asymptomatic recurrence.
Method: We reviewed our experience with 136 patients undergoing LPH repair over a six year period. All patients beyond 1 year of LPH in whom an esophogram was obtained were identified. Concurrently, symptom scores (SS) for chest pain, heartburn, regurgitation, and dysphagia were obtained and the highest score reported by the patient was tabulated (0 = no symptoms; 1 = mild symptoms; 2 = moderate; and 3 = severe symptoms). Additionally, a measure of patient satisfaction, frequency of medication use, and the need for extraordinary physician visits or hospitalizations were documented.
Results: In 42 patients, a barium swallow at a mean of 45 months (range 20 - 82 months) after LPH repair were available or obtained. There were 14 males and 28 females with an average age of 63.2 years (range 42 90 years). Thirty-eight patients completed symptom questionnaires with 90% expressing satisfaction with the results of the operation. Twenty-eight patients (74%) were off medications and 5 (13%) had visited a physician with related symptoms. Fourteen patients (33%) had an anatomic recurrence on esophogram, but only 3 of these patients reported more than mild symptoms. The symptom scores of those with anatomic recurrence were not significantly different than in those without recurrence (see graph). Only one patient with recurrence has undergone reoperation for postprandial pain.
Conclusion: At long-term follow up, anatomic recurrence following LPH repair is high. Many of these are asymptomatic and of questionable clinical significance. The relevance of recurrent asymptomatic paraesophageal hernia remains unclear, and at this time it is difficult to recommend reoperation for these patients.