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Surgical Endoscopy
Published in: Surgical Endoscopy 8/2006

01-08-2006

Laparoscopic repair of large paraesophageal hiatus hernia: quality of life and durability

Authors: R. Parameswaran, A. Ali, S. Velmurugan, S. E. Adjepong, A. Sigurdsson

Published in: Surgical Endoscopy | Issue 8/2006

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Abstract

Background

Laparoscopic repair of large paraesophageal hiatus hernias (LPOHH) is shown to be a safe and effective operation in the short term. However, its long-term durability and its effect on quality of life are less well established. This study aimed to assess the midterm outcome for laparoscopic repair of LPOHH with validated quality-of-life symptom scores and barium studies.

Methods

Between January 2000 and July 2004, 49 patients (27 women) with LPOHH underwent laparoscopic repair. The median age of these patients was 68 years (range, 38–90 years). The laparoscopic repair included resection of the hernia sac, reduction of its contents, esophageal mobilization up to the aortic arch, crural repair with sutures (mesh reinforcement in 17 cases), Nissen fundoplication, and fixation of the wrap to the crura. Follow-up assessment was prospective with quality-of-life questionnaires, the Gastrointestinal Symptom Rating Scale (GSRS), the Gastroesophageal Reflux Disease–Health-Related Quality of Life (GERD-HRQOL) scale, and barium studies.

Results

The presenting symptoms were pain for 21 patients, reflux for 27 patients, bleeding or anemia for 14 patients, and dysphagia for 17 patients. Five emergency operations were performed. Short esophagus was present in 24 patients. There were two conversions to open surgery. The major morbidity (atrial fibrillation, pulmonary embolism, and splenectomy) rate was 10.2%, and the minor morbidity (chest infection, jaundice, dysphagia, small pneumothorax) rate was 20.4%. Six patients were deceased of unrelated causes at the time of follow-up evaluation. Responses to the questionnaires were obtained in 31 cases (75%). Using the Wilcoxon signed rank test, the results from the questionnaires showed a statistically significant improvement (p < 0.001) in abdominal pain, reflux, and indigestion scores (GSRS) and GERD-HRQOL scores. Follow-up barium studies for 27 patients (66%) showed recurrence in 4 patients (14.8%), 2 of which were symptomatic.

Conclusion

Laparoscopic repair of LPOHH is associated with good quality of life as well as an acceptable midterm recurrence rate.
Literature
1.
2.
Ozdemir IA, Burke WA, Ikins PM (1973) Paraoesophageal hernia: a life-threatening disease. Ann Thorac Surg 16: 547–554PubMedCrossRef
3.
Schauer PR, Ikramuddin S, McLaughlin RH, Graham TO, Slivka A, Lee KK, Schraut WH, Luketich JD (1998) Comparison of laparoscopic versus open repair of paraoesophageal hernia. Am J Surg 176: 659–665PubMedCrossRef
4.
Khaitan L, Houston H, Sharp K, Holzman M, Richards W (2002) Laparoscopic paraoesophageal hernia has an acceptable recurrence rate. Am Surg 68: 546–552PubMed
5.
Mattar SG, Bowers SP, Galloway KD, Hunter JG, Smith CD (2002) Long-term outcome of laporoscopic repair of paraoesophageal hernia. Surg Endosc 16: 754–749CrossRef
6.
Edye MB, Canin-Endres J, Gattomo F, Salky BA (1998) Durability of laparoscopic repair of paraoesophageal hernia. Ann Surg 228: 528–535PubMedCrossRef
7.
Aly A, Munt J, Jamieson GG, Ludemann R, Devitt PG, Watson DI (2005) Laparoscopic repair of large hiatal hernias. Br J Surg 92: 648–653PubMedCrossRef
8.
Revicki DA, Wood M, Wiklund I, Crawley J (1998) Reliability and validity of the Gasrtointestinal Symptom Rating Scale in patients with gastrooesophageal reflux disease. Qual Life Res 7: 75–83PubMedCrossRef
9.
Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality-of-life scale after gastrooesophageal reflux disease. J Am Coll Surg 186(3): 217–214
10.
Cuschieri A, Shimi S, Nathanson L (1992) Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia. Am J Surg 163: 425–430PubMedCrossRef
11.
Oelschlager BK, Pelligrini CA (2001) Paraoesophageal hernias: open or laparoscopic or thoracoscopic repair? Chest Surg Clin North Am 11: 589–603
12.
Freeman ME, Hinder RA (2001) Laparoscopic paraoesophageal repair. Semin Laparoscopic Surg 8: 240–245CrossRef
13.
Skinner DB, Belsey RH (1967) Surgical management of oesophageal reflux and hiatus hernia: long term-results in 1,030 patients. J Thorac Cardivasc Surg 53: 33–54
14.
Allen MS, Trastek VF, Deschamps C, Pairolero PC (1993) Intrathoracic stomach: presentation and results of operation. J Thorac Cardiovasc Surg 105: 252–259
15.
Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraoesophageal hernias: operation or observation? Ann Surg 236: 492–500PubMedCrossRef
16.
Pierre AF, Luketich JD, Fernando HC, et al. (2002) Results of laparoscopic repair of giant paraoesophageal hernias: 200 consecutive patients. Ann Thorac Surg 74: 1909–1915PubMedCrossRef
17.
Luketich JD, Raja S, Fernando HC, Campbell W, Christie NA, Buenaventure PO, et al. (2000) Laparoscopic repair of giant paraoesophageal hernia: 100 consecutive cases. Ann Surg 232: 608–618PubMedCrossRef
18.
Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, et al. (2000) Laparoscopic repair of large type III hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg 190: 533–560CrossRef
19.
Wu JS, Dunnegan DL, Soper NJ (1999) Clinical and radiological assessment of laparoscopic paraoesophageal hernia repair. Surg Endosc 13: 497–502PubMedCrossRef
20.
Dahlberg PS, Deschamps C, Miller DL, Allen MS, Nichols FC, Pairolero PC (2001) Laparoscopic repair of large paraoesophageal hiatal hernia. Ann Thorac Surg 72: 1125–1129PubMedCrossRef
21.
Andujar JJ, Papasavas PK, Birdas T, Robke J, Raftopoulos Y, Gagne DJ, et al. (2004) Laparoscopic repair of large paraoesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc 18: 444–447PubMedCrossRef
22.
Diaz S, Brunt LM, Klingensmith ME, Frisella PM, Soper NJ (2003) Laparoscopic paraoesophageal hernia repair: a challenging operation: medium-term outcome of 116 patients. J Gastroint Surg 7: 59–66CrossRef
23.
Fernando HC, Schauer PR, Rosenblat M, Wald A, Buenaventura P, Ikrammudin S, Luketich JD (2002) Quality of life after antireflux surgery compared with nonoperative management for severe gastrooesophageal reflux disease. J Am Coll Surg 194: 23–27PubMedCrossRef
24.
Mobius C, Stein HJ, Feith M, Feussner H, Siewert JR (2001) Quality of life before and after laparoscopic Nissen fundoplication. Surg Endosc 15(4): 335–356CrossRef
25.
Velanovich V, Karmy-Jones R (2001) Surgical management of paraoesophageal hernias: outcome and quality-of-life analysis. Dig Surg 18: 432–437PubMedCrossRef
26.
Targarona EM, Novell J, Velas, et al. (2004) Midterm analysis of safety and quality of life after the laparoscopic repair of paraoesophageal hiatal hernia. Surg Endosc 18: 1045–1050PubMedCrossRef
27.
Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP (2002) A prospective randomised trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137: 649–652PubMedCrossRef
28.
Oelschlager BK, Barreca M, Chang L, Pellegrini CA (2003) The use of small intestine submucosa in the repair of paraoesophageal hernias: initial observations of a new technique. Am J Surg 186: 4–8PubMedCrossRef
29.
Weichmann RJ, Ferguson MK, Naunheim KS, Mckesey P, Hazelrigg SJ, Santucci TS, Macherey RS (2001) Laparoscopic management of giant paraoesophageal herniation. Ann Thoracic Surgery 71: 1080–1087CrossRef
Metadata
Title
Laparoscopic repair of large paraesophageal hiatus hernia: quality of life and durability
Authors
R. Parameswaran
A. Ali
S. Velmurugan
S. E. Adjepong
A. Sigurdsson
Publication date
01-08-2006
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 8/2006
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-005-0691-7

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