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Long-Term Results After Minimally Invasive Repair of Giant Paraesophageal Hernia in 105 Patients
Katie S. Nason*, James D. Luketich, Rodney J. Landreneau, Irfan Qureshi, Samuel B. Keeley, Shannon E. Trainor, Manisha Shende, Arjun Pennathur
Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
Background: Laparoscopic repair of giant paraesophageal hernias (LRGPEH) is increasingly utilized with excellent short-term results. Long-term (>60 months) clinical and radiographic results, however, are poorly described. Our objective was to evaluate the long term results after minimally invasive repair of GPEH.
Methods: We performed a review of patients undergoing elective LRGPEH (1995 to 2002) who had a minimum of 60-month clinical or radiographic follow-up. Clinical outcomes, barium swallow and quality-of-life measures were reviewed.
Results: There were 256 patients who underwent LRGPEH in this time-period. A minimum of 60-month clinical or radiographic follow-up was available on 105 patients. Hernia reduction, sac excision, crural repair (13.7% mesh-reinforcement) and fundoplication were performed in 98%. A Collis-gastroplasty was performed in 89 patients (85%). Median time for clinical follow-up was 82 months (60-124). GERD-Health-Related-Quality-of-Life (GERD-HRQL) scores were available for 98 patients, with a mean 3.9 ±6 (median 1, range 0-23; 0=no symptoms-45= worst). Occasional heartburn and dysphagia to solids were the most common persistent symptoms in 30% of patients. According to the GERD-HRQL scale (excellent=0-5; good=6-10; fair=11-15; poor=16-45), the results were excellent to good in 86.8% of patients, confirming the mild nature of the symptoms. Barium-swallow was obtained in 79/105 (75%) at a median time of 80 months (60-126). Radiographic recurrence of a hiatal hernia was identified in 9 (11%). GERD-HRQL scores were excellent in 77% of patients with radiographic recurrence compared to 72% in patients without radiographic recurrence. When patients were queried regarding satisfaction with surgery, over 90% (83/90) were satisfied or very satisfied. Re-operation was required in 5 (4.7%) patients for symptomatic recurrence at a median 44 months post-operative (range 8-80).
Conclusions: This report summarizes the long-term results (7 years) of LRGPEH in 105 patients. Reoperation was required for symptomatic recurrence in only 4.7%. The GERD-related quality of life was well preserved and 90% of patients were satisfied with their surgery.
