FUNDOPLICATION AT THE TIME OF HIATAL HERNIA REPAIR MAY NOT REDUCE POSTOPERATIVE REFLUX
Shankar Logarajah*, Jessica C. Heard, Jashwanth Karumuri, David Ahle, Houssam Osman, D Rohan Jeyarajah
Hepatobilary Surgery, Methodist Richardson Medical Center, Richardson, TX
Introduction
Performing a fundoplication procedure at the time of hiatal hernia repair is standard of care during the repair of type I hiatal hernias. Few prior studies have examined the necessity of this procedure in paraesophageal hernia repairs. We sought to examine whether fundoplication performance at the time of paraesophageal hernia repair was associated with reduced post-operative reflux symptoms.
Methods and Procedures
This is a retrospective review of patients who underwent paraesophageal hernia repair at a single institution. Fundoplication at the time of paraesophageal hernia repair was based on surgeon discretion. Pre-operative comorbidities were noted and a detailed chart review of perioperative course was conducted to identify patient outcomes including the development of reflux symptoms, nausea or vomiting, and dysphagia. Univariate analysis was then conducted between patients who had a fundoplication procedure performed at the time of hiatal hernia repair and those who did not.
Results
262 patients who underwent paraesophageal hernia repair were identified between 2014 and 2020. 132 patients (50.4%) underwent fundoplication as part of their hernia repair. When stratified by fundoplication status, those who underwent fundoplication showed no significant difference in gender (p = 0.933) or comorbidities. Of those who underwent fundoplication, Dor fundoplication was the most common (70.5%) followed by Toupet (15.1%) with Nissen fundoplication being the most rare (14.4%). Pre-operative reported symptoms were similar among both study groups with regards to dysphagia (p = 0.269), reflux (p = 0.174), and regurgitation (p = 0.260). Notably, patients who reported pre-operative nausea and vomiting were less likely to undergo fundoplication (p = 0.013). When post-operative symptoms were analysed by fundoplication status, there were no significant differences in dysphagia (p = 0.890), reflux (p = 0.209), regurgitation (p = 0.231) or nausea and vomiting (p = 0.546).
Conclusion
Fundoplication at time of paraesophageal hernia repair remains a topic of large uncertainty with prior studies showing mixed results regarding reduction in post operative symptoms. Our results suggest that fundoplication performed at the time of PEH repair is not correlated with a reduction in post-operative symptoms and may not be a necessary part of the procedure for PEH repair as previously thought.
Table 1. Characteristics of Patients
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