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Resolution of Anemia Following Repair of Giant Paraesophageal Hernias
Michael Hermansson*, Steven R. Demeester, Joerg Zehetner, Kimberly S. Grant, Daniel S. OH, Tom R. Demeester, Jeffrey a. Hagen
Surgery, Keck medical center of USC, University of Southern California, Los Angeles, CA
Background and Aim
The association between anemia and paraesophageal hernia (PEH) was reported in 1931. Nonetheless, extensive evaluation for a source of bleeding in patients with anemia and PEH is common. The aim of this study was to evaluate the prevalence of anemia in patients with PEH and the impact of surgical PEH repair on anemia.
Methods
A retrospective chart review was performed of all patients who underwent primary repair of a PEH with 50% or more of the stomach in the chest between May 1998 and January 2010. Patients with incomplete or missing records were excluded. Patients with a history of anemia were contacted postoperatively and the status of their anemia was determined.
Results
There were 118 patients that met the inclusion criteria. A history of anemia was present in 41 patients (35%), and these patients formed the study group. There were 14 males (34%) and 27 females (66%). The mean age was 64 years. The median duration of anemia prior to PEH repair was 4 years. Treatment for anemia consisted of oral iron supplements (n=17), intravenous iron infusions (n=2) and blood transfusions (n=11). Evaluations for anemia consisted of upper endoscopy (n=41), colonoscopy (n=20), capsule enteroscopy (n=3), push enteroscopy (n=1), and tagged red blood scan (n=2). In the 41 patients with preoperative anemia detailed postoperative follow-up was available in 23 patients (56%). The median follow-up for these 23 patients was 59 months (range 25-133). Resolution of anemia occurred in 18 patients (78%). In 5 patients anemia has persisted and they remain on oral iron supplements. The median follow-up in these patients did not differ from those with resolution of their anemia. No patient has required a blood transfusion or intravenous iron infusion after PEH repair. A recurrent hernia was found in 2 of those 5 patients
Conclusion
Anemia is common in patients with a giant PEH, and surgical PEH repair resolved the anemia in 78% of patients. Therefore, repair of a giant PEH is indicated in patients with anemia. Extensive evaluations for an alternative explanation for the anemia in patients with a giant PEH are unlikely to be useful.
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