EFFECT OF LAPAROSCOPIC HIATAL HERNIA REPAIR ON PULMONARY FUNCTION
Norbert Hootsmans*, Alex Addo, Justin Turcotte, Adrian Park
Luminis Health Inc, Annapolis, MD
Background
Dyspnea is a common symptom associated with paraesophageal hernias. Previous studies offer mixed evidence on whether hiatal hernia repair significantly improves objective respiratory parameters, and have mainly been limited in scope to large paraesophageal hernias. This study aims to determine the effect of laparoscopic hiatal hernia repair on respiratory function in a population inclusive of all hiatal hernia types.
Methods
A retrospective study of 45 patients undergoing laparoscopic repair of symptomatic hiatal hernias between November 1, 2021 and October 31, 2022 was performed. All patients completed pulmonary function testing (PFT) prior to surgery and postoperatively. PFT components assessed included peak flow, forced vital capacity (FVC), forced expiratory volume (FEV1), and FEV1/FVC ratio. Descriptive statistics were performed to assess patient demographics, comorbidities, American Society of Anesthesiologists (ASA) score, and the percent of intrathoracic stomach at the time of surgery. Paired-samples t-tests were used to compare changes in pulmonary function before and after surgical repair. Multivariate linear regression was performed to assess the relationship between baseline characteristics and change in PFT measures.
Results
The cohort had a median age and body mass index (BMI) of 68.3 ± 9.7 years and 26.5 ± 3.9 kg/m2, respectively. About 13.3% of patients were obese and 71% were female. One-third of patients had an ASA score ≥ 3, 42% were former smokers, 8.9% had chronic obstructive pulmonary disease (COPD), 13.3% had asthma, and 6.7% had obstructive sleep apnea (OSA). Fifty percent and 33% of patients had >50% and >75% intrathoracic stomach, respectively. At baseline, female sex, former smokers, and patients with COPD demonstrated lower levels of pulmonary function (p<0.05 on at least one measure), while obesity, ASA scores, asthma, OSA, and percent of stomach herniation were not associated with significant differences in PFT measures. The median time to follow up PFT was 31 days (IQR: 30-37 days). All PFT measures significantly improved after surgery (all p<0.001, Table 1), with a 12.4% increase in FEV1, and 43 of 45 patients (96%) experienced improvement in at least one PFT measure. In the multivariate models, no significant relationships between age, sex, obesity, ASA score, pulmonary comorbidities, or percent of intrathoracic stomach, and change in any PFT measures were found.
Conclusions
Laparoscopic hiatal hernia repair significantly improves respiratory function as measured by spirometry, and may provide clinical improvement in respiratory function given the relative increase in FEV1. This effect is not limited to large or giant paraesophageal hernias, and no correlation was found between percent intrathoracic stomach and improvement in respiratory parameters.
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