|
Back to 2015 Annual Meeting Program
One-Year Outcomes of Laparoscopic Paraesophageal Hernia Repair Stratified by Hernia Size
Daniel Davila*, Matthew J. Frelich, Matthew I. Goldblatt, James R. Wallace, Andrew Kastenmeier, Jon Gould
General Surgery, Medical College of Wisconsin, Milwaukee, WI
Background: Laparoscopic repair of symptomatic paraesophageal hernias (PEH) has been demonstrated to be safe. While factors such as patient age have been demonstrated to correlate with the risk of postoperative morbidity and mortality, we hypothesized that the complexity of the hernia itself (based on hernia size) is also a significant factor in postoperative outcomes.
Methods: This is a retrospective review of prospectively maintained data. All subjects underwent laparoscopic PEH at a single institution from June 2010 to June 2014. Hernia size was calculated based on CT scan or upper GI esophagram and categorized as less than 50% (group 1) or greater than 50% herniated (group 2). All paraesophageal hernias included in this study were symptomatic (epigastric pain after eating, dysphagia, or vomiting/retching). The Gastro-Intestinal Quality of Life Index (GIQLI) questionnaire was used to assess symptoms pre and post-surgery.
Results: A total of 89 patients underwent primary laparoscopic PEH repair during the study interval. There were no mortalities. Three patients (3.4%) underwent urgent repair. Most patients (47, 52.8%) met group 1 criteria. The study population was mostly female (74, 83.1%) with a mean BMI of 36.0±19.4 kg/m2.
Conclusions: Patients with larger paraesophageal hernias tend to be older. These hernias take longer to repair laparoscopically and duration of hospital stay is increased. Despite these facts, complications and readmissions occurred at a similar rate, and gastrointestinal quality of life consistently improved in both groups. In the hands of experienced surgeons, laparoscopic repair of large paraesophageal hernias is associated with excellent outcomes.
| Age (years) | OR Time (minutes) | LOS (days) | Perioperative Complication Rate | 30 Day Complication Rate | 30 Day Readmission Rate | GIQLI pre-op | GIQLI 1y post-op | | Group 1 (<50) | 54.8 (±12.1) | 168.9 (±58.7) | 2.0 (±1.5) | 4 (8.5%) | 2 (4.3%) | 3 (6.4%) | 73.6 (±18.8) | 88.0 (±37.2) | | Group 2 (≥50%) | 68.1 (±12.3)
| 219.7 (±76.4) | 3.3 (±2.5) | 6 (14.3%) | 3 (7.1%) | 7 (16.7%) | 80.0 (±20.1) | 97.3 (±23.0) | | p-value | <0.01 | <0.01 | <0.01 | 0.51 | 0.66 | 0.18 | 0.27 | 0.37 |
*Indicates significant differences p<0.05. GIQLI: A high score is desirable.
Back to 2015 Annual Meeting Program
|
