2005 Abstracts: Laparoscopic Repair of Paraesophageal Hernia with Placement of a Gastrostomy Tube Is Associated with Low Recurrence
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Laparoscopic Repair of Paraesophageal Hernia with Placement of a Gastrostomy Tube Is Associated with Low Recurrence
Daniel Howell, Emory University, Tucker, GA
LAPAROSCOPIC REPAIR OF PARAESOPHAGELA HERNIA WITH PLACEMENT OF A GASTROSTOMY TUBE IS ASSOCIATED WITH LOW RECURRENCE
DL Howell, L Khaitan, CD Smith, Emory Endosurgery Unit, Emory University School of Medicine, Atlanta, GA. Background: Laparoscopic repair of paraesophageal hernias (PEH) has been reported to have a recurrence rate over 40% compared to a much lower recurrence rate with open repair at 8-10%. The technique of surgical repair is closely associated with recurrence. The purpose of this study is to review whether laparoscopic PEH repair performed with placement of a percutaneous gastrostomy tube (GT) can improve the previously high reported recurrence rates and improve symptom relief. Methods: Using a prospectively maintained, IRB approved database, we identified 54 patients who underwent PEH repair with GT from 1/2002 to 11/2004. Using a standardized questionnaire, post-operative symptoms of chest pain, regurgitation, dysphagia, bloating, and nausea were recorded on a 4-part Likert scale. Patients with moderate to severe symptoms were further evaluated with barium swallow. Data was collected regarding the operative procedure and complications. Results: Fifty-two patients were included with a mean follow up of 3 months (range 1-21 months). All patients had laparoscopic PEH repair with pledgeted sutures to repair the cura, excision of the sac, and placement of a GT. Fifty patients had an anti-reflux procedure (Nissen fundoplication or Toupet). Patients were high risk with a mean American Society of Anesthesiologists (ASA) score of 3.8, and age of 64 (range 31 to 86). One patient developed post-operative pneumonia with intubation, one had recurrence within 30 days requiring re-operation, and one developed stricture requiring endoscopic dilatation. Two patients were unable to have their hernias completely repaired and were excluded from the study. No fatalities were recorded.23% of the patients experienced moderate to severe chest pain, regurgitation, dysphagia, or nausea at one month post-operatively which decreased to 6% after one month. Bloating was only reported as a symptom in 6% at one-month follow up. Of the 18 barium swallows obtained, there were only 3 recurrences, 6%. Conclusion: Insertion of a GT at time of PEH repair is associated with a 6% recurrence rate. The laparoscopic repair has minimal morbidity and mortality in high-risk patients.
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