Abstracts
1999 Digestive Disease Week

# 2113 LAPAROSCOPIC PARAESOPHAGEAL HERNIA REPAIR PROVIDES SYMPTOM RELIEF COMPARABLE TO NISSEN FUNDOPLICATION
C Anthony Kim, C D Smith, Timothy M Farrell, K D Galloway, Emory Univ Sch of Medicine, Atlanta, GA; Gene D Branum, Emory Univ, Atlanta, GA; John G Hunter, Emory Univ Sch of Medicine, Atlanta, GA

Background/Objective: While the excellent clinical outcomes following laparoscopic Nissen fundoplication (LNF) have been clearly established, the effectiveness of laparoscopic repair of paraesophageal hernia (LPH) remains poorly defined. To further establish the clinical outcomes following LPH, we compared patient symptom scores following LPH with those following LNF.
Methods: Between 1992-1998, 87 patients underwent primary LPH. All repairs routinely included a fundoplication. Using a 0-3 scale (0=none, 1=mild, 2=moderate, 3=severe), symptom scores for typical (heartburn, regurgitation, and dysphagia) and atypical (chest pains) symptoms were obtained preoperatively, and post-operatively at 6 weeks and annually thereafter. Forty-eight patients were available for long-term follow-up at an average of 25 months post-operatively (range=4-62 months). This group was compared to an age- and sex-matched group of patients who underwent LNF during the same time period. Comparisons within groups were made using Wilcoxon Signed Ranks test, and between groups using Wilcoxon Rank Sum test.
Results: In the preoperative period, only heartburn was significantly different in its severity between the paraesophageal and the Nissen groups, with Nissen patients having higher heartburn scores (p<0.05). All other symptom score distribnutions were similar. Post-operatively, LPH and LNF each showed significant improvement for all four symptoms (p<0.05), and the severity scores were similar between the two groups (p>0.05). A representative graph of chest pain symptom score comparison is shown.
Conclusion: Laparoscopic paraesophageal hernia repair results in excellent long-term clinical outcomes with relief of pre-operative symptoms comparable to those who undergo laparoscopic Nissen fundoplication.

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