INCREASED FREQUENCY OF GIANT PARAESOPHAGEAL HERNIA REPAIR AT A SAFETY NET HOSPITAL
Adeline Deladisma, Daniel Escobar*, Alvancin Louis, Moustapha Dimachk, Brian G. Dalton, Ziad Awad, Ruchir Puri
Surgery, University of Florida, Jacksonville, FL
INTRODUCTION
Hiatal hernias (HH) affect a large segment of the American population. Surgical repair is performed either in conjunction with anti-reflux surgery (ARS) for gastroesophageal reflux disease (GERD) or for symptomatic paraesophageal hernias (PEH). Paraesophageal hernias are often underappreciated and affect the elderly. Referrals for surgical repair are typically made later in life when patient develop significant symptoms and have a large PEH. We performed a review of giant PEH repaired at our academic safety net hospital.
METHODS
An IRB-approved, retrospective chart review of all HH repairs at University of Florida, Jacksonville from August 2013 to August 2018 was performed. Patients who had a hiatal hernia repair concomitant with a gastric bypass were excluded. A total of 112 patients were identified and divided into two groups: Group I (Type I HH or PEH with less than 50% intrathoracic stomach (ITS), n=60) and Group II (Giant PEH- greater than 50% ITS, n=52). Size of the HH was assessed on preoperative imaging and/or intraoperatively. Patient demographics, preoperative symptoms, operative findings and postoperative outcomes were assessed.
RESULTS
Sixteen (14.2%) patients had type I HH while 96 (85.7%) had either type II, III or IV PEH. Fifty-two (54.1%) of all PEH were giant. In bivariate analysis, age > 60, BMI > 25, heartburn or shortness of breath on presentation, and presence of comorbidities emerged as potential risk factors for giant PEH among all with HH (Table 1). In a multivariate model, age > 60 significantly increased the odds of having a giant PEH (OR = 3.08), while presence of heartburn was a significant protective risk factor (OR = 0.35). Complications occurred in 18 patients (16.1%) and there was one death. Follow up was limited mainly to patients who had ongoing symptoms. Overall, 19/104 patients (18.3%) had documented recurrence of symptoms and 12/106 (11.3%) had recurrence of a hernia.
CONCLUSION
In our safety net hospital majority of the hiatal hernia repairs were performed for symptomatic PEH with a significant number of these PEH being giant is size. Most patients even with giant paraesophageal hernias experience relief of their symptoms after repair.
Table 1: Bivariate and Multivariate Analysis of factors associated with giant paraesophageal hernias (PEH)
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