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Quality of Life After Paraesophageal Hernia Repair - Does Fundoplication Help?
Wendy Jo Svetanoff*, Pradeep K. Pallati, Kush R. Lohani, Sumeet K. Mittal
Department of Surgery, Creighton University, Omaha, NE
OBJECTIVE: The objective is to determine whether patients had better quality of life (QOL) related to Gastro-Esophageal Reflux Disease (GERD) when undergoing paraesophageal hernia (PEH) repair with fundoplication compared to repairing the PEH alone.
BACKGROUND: Very few studies have been performed comparing the outcome and necessity of performing a fundoplication while repairing a PEH. Even less research is available comparing the long-term quality of life benefits of performing a fundoplication versus a PEH repair alone in controlling reflux symptoms.
DESIGN: A prospective paraesophageal hernia database is maintained on all patients who underwent PEH repair. A questionnaire was derived from the Quality of Life in Reflux and Dyspepsia (QOLRAD) and Frequency Scale for Symptoms of GERD (FSSG) questionnaires to assess for continued symptoms of reflux despite surgical treatment. Patients from the database were then contacted to answer the survey questions. Fisher's exact test was used to compare the incident of each symptom between the fundoplication group and the PEH repair only group.
SETTING This study was performed at a tertiary academic hospital.
PATIENTS: Patients who underwent surgery for an intrathoracic stomach or paraesophageal hernia were included. Between 2004 and 2013, 110 patients underwent PEH repair with fundoplication and 42 patients had PEH repair alone.
OUTCOME MEASURES: Quality of life after the initial surgery and need for further procedures or medications were measured.
RESULTS: The response rate was 49% in the PEH repair with fundoplication group with a median follow-up time of 7 ½ years and 43% in the PEH repair alone group with a median follow-up time of 4 1/3 years. Significantly more patients woke up at night due to reflux symptoms (p=0.03) and found themselves coughing around mealtime (p=0.05) in the fundoplication group compared to the PEH repair alone group. In the PEH repair only group, daytime regurgitation and dysphagia to solid foods were trending near statistical significance (p = 0.06). 18% of patients in the fundoplication group admitted to taking some type of antacid medications, while 6% of patients in the PEH repair group did, despite a similar percentage of patients complaining of regurgitation or heartburn pre-operatively between the two groups (41% to 39% for regurgitation and 68% to 61% for heartburn, respectively). There were 2 patients in both groups that had to have additional procedures (EGD +/- dilatation) for symptoms.
CONCLUSIONS: In patients presenting with symptoms related to paraesophageal hernia itself, there is no added benefit of combining fundoplication with regard to long-term quality of life.
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