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Symptomatic Relief After Laparoscopic Paraesophageal Hernia (Lpeh) Repair.
Mauricio G. Ramirez*1, Rym El Khoury2, Marco G. Patti1, Nathaniel J. Soper2, Eric S. Hungness2
1General Surgery, University of Chicago, Chicago, IL; 2General Surgery, Northwestern Universirty, Chicago, IL
Background: LPEH repair is considered today the standard of care for this condition. While attention has been mostly focused on the incidence of radiologic recurrence, few data are available about the effect of the operation on symptoms.
Aims: To determine the effect of LPEH repair on symptoms.
Patients and methods: One hundred and sixty two patients underwent LPEH repair in two academic tertiary care centers. Preoperative evaluation included a barium swallow (100%), endoscopy (80%), manometry (81%) and pH monitoring (25%). Type III PEH was the most common (94%), and it was associated with a gastric volvulus in 26.5%.
Results: Average duration of the operation was 147 minutes. Average EBL was 80 cc. A fundoplication was performed in all patients, Nissen in 83%, Dor in 6%, Toupet in 11%, and Collis was performed in 6.1%. Intra-operative complications occurred in 7%. The operation was completed laparoscopically in 97% patients. Four percent of patients had postoperative complications, and three needed a second operation. Table 1 shows the symptomatic evaluation before and after the operation. Average follow-up was 24 months.
Conclusions: LPEH repair is safe and effective. Few patients experience post-operative symptoms and these are easily controlled with acid reducing medications.
Table 1
| Symptom (% patients) | Preoperative | Postoperative | p Value | | Heartburn | 72% | 15% | 0.0006 | | Regurgitation | 64% | 10% | 0.0117 | | Cough/asthma | 51% | 10% | 0.0074 | | Anemia | 13% | 0 | 0.0025 | | Dysphagia | 44% | 17% | 0.5328 |
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