|
|
Back to 2014 Annual Meeting Posters
Esophageal Shortening Ratio Provides a Simple Calculation to Predict Clinically Significant Esophageal Shortening in Patients With Giant Paraesophageal Hernias
Stephen J. Kaplan*1,3, Carol S. Murakami2,3, Henner M. Schmidt1,3, Donald E. Low1,3
1Department of General, Thoracic and Vascular surgery, Virginia Mason Medical Center, Seattle, WA; 2Department of Gastroenterology, Virginia Mason Medical Center, Seattle, WA; 3Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA
Background:
Clinically significant esophageal shortening (ES) in patients with giant paraesophageal hernias (PEH) can complicate the surgical repair. Accurate prediction of ES in patients with PEH would help guide operative planning. A validated pre-operative indicator of ES has yet to be described. The purpose of this study is to assess esophageal shortening ratio (ES ratio) utilizing esophageal length measured with high resolution manometry (HRM) as a predictor of ES in patients undergoing PEH repair.
Methods:
Between 1/2008 and 9/2013, 125 consecutive patients undergoing PEH repair at a single institution were entered in a prospectively maintained database. 102 patients with complete datasets were included. An ES group of 31 patients, defined by the surgeons intraoperative decision to perform a Hill repair with gastropexy or gastrostomy as a surrogate for ES, was compared to a non-ES group of 71 patients. Patient demographics, diagnostic results, intraoperative findings and outcomes were assessed. HRM was obtained pre-operatively in all patients and then retrospectively re-evaluated by a single gastroenterologist (C.M.) specialized in manometric interpretation. Manometric esophageal length was measured from the lower border of the upper esophageal sphincter and the upper border of the lower esophageal sphincter. ES ratio was calculated by dividing manometric esophageal length by body height.
Results:
Age, BMI, hernia type and manometric esophageal length were not statistically different between groups. ES patients were taller than non-ES patients (166 cm [160-178] vs. 160 cm [156-165], p=0.002) and had a higher incidence of male sex (13 [42%] vs. 9 [13%], p=0.001). However, when stratified by sex, there were no differences in height between ES and non-ES groups (males, p=0.122; females, p=0.464). Mean ES ratio was less in the ES group (9.3±1.5% vs 10.0±1.3%, p=0.01). In a multivariate logistic regression model, the odds of ES were 9.8-times greater in patients with an ES ratio less than 8.5%, and 3.4-times greater in patients with an ES ratio between 8.5% and 9.5%, when compared to those with an ES ratio of 9.5% or greater (95%CI 2.5-39.5, p=0.001; 95%CI 1.2-10.0, p=0.027). Additionally, the odds of ES was 6.1-times greater for males compared to females (95%CI 2.0-18.6, p=0.001).
Conclusion:
Patients with an ES ratio < 8.5% have a greater chance of clinically significant ES, and thus may also require a more complex surgical repair. The ES ratio can be easily calculated with HRM, and may be an important measurement for operative planning.
Back to 2014 Annual Meeting Posters
|
