EFFECTS OF SPINAL DEFORMITIES ON HIATAL HERNIA OCCURRENCE AND RECURRENCE
Naveen Perisetla*, William N. Doyle, Ladehoff Lauren, Nicole Natarelli, Valerie Nemov, Karthik Pittala, Joseph Sujka, Adham R. Saad, Christopher DuCoin, Vic Velanovich
Surgery, University of South Florida, Tampa, FL
Background: Spinal deformities such as kyphosis, lordosis, and scoliosis can distort the diaphragm. Older studies have demonstrated a possible association between these deformities, especially kyphosis, and hiatal hernia occurrence and size. Nevertheless, there is a paucity of information on the effects of such spinal deformities on the preoperative presentation and postoperative recurrence of hiatal hernia. Our hypothesis is that the presence of spinal deformities will increase the risk of hiatal hernia recurrence after repair.
Methods: The medical records of patients undergoing hiatal hernia repair from 2009 to 2021, were reviewed for the following information: age (yrs.), sex (male/female), body mass index, co-morbidities, date of hiatal hernia repair, preoperative GERD symptoms, presence and type of spinal deformity (kyphosis, lordosis, scoliosis, multiple), Cobb angle (degrees), type of hiatal hernia and size (cm), type of hiatal hernia repair, recurrence and size (cm), time to recurrence (months), reoperation, type of reoperation, and time to reoperation (months). Statistical analysis was done with chi-squared test for categorical data, Students' t-test for normal-distributed continuous data, and Mann-Whitney U-test for non-normal-distributed continuous data.
Results: Of the 449 patients undergoing hiatal hernia repair, 68 (17.8%) had some type of spinal deformity. The distribution of spinal deformity types were kyphosis 16 (23.5%), lordosis 1 (1.5%), scoliosis 41 (60.3%), and multiple 10 (14.7%). Those patients with spinal deformities were more likely to be female compared to those without deformities (83.8% vs 70.9%, p=0.03) and to be of older age (63.5+13.1 vs 58.5+14.5, p=0.009). Although not reaching statistical significance, spinal deformity patients had a preoperative GERD symptom rate of 97.1% compared to 90.8% for patients without spinal deformities (p=0.08). There was no significant difference in the distribution of sliding vs paraesophageal hernias (63.6% vs 56.1%, p= 0.3). Patients with spinal deformities had significantly larger hernias (6.4+2.6 vs 4.6+2.1, p=0.00001), higher recurrence rates (45.6% vs 28.1%, p=0.004) shorter time to recurrence (median [IQR] 13.8 [5.6-24.5] vs 21 [12.5-51.8], p=0.02), and fewer reoperations (58.1% vs 75.7%, p=0.05). There was no significant difference in recurrent hernia size (p=0.9).
Conclusions: Patients with spinal deformities were significantly more likely to have larger hiatal hernias. This group is at higher risk of hiatal hernia recurrence after repair with shorter times to recurrence. They were less likely to have their recurrences repaired despite having similar size recurrences. This is a group that requires special attention with additional preoperative counseling and possibly use of surgical adjuncts in repair.
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