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Published in: Surgical Endoscopy 4/2018

01-04-2018

Long-term clinical outcomes after intrathoracic stomach surgery: a decade of longitudinal follow-up

Authors: Allison M. Blake, Sumeet K. Mittal

Published in: Surgical Endoscopy | Issue 4/2018

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Abstract

Background

A subset of patients with large paraesophageal hernias have more than 75% of the stomach herniated above the diaphragm; such cases are referred to as intrathoracic stomach (ITS). Herein, we report longitudinal symptomatic outcomes over a decade after surgical ITS repair in a large patient cohort.

Methods

Patients who underwent surgical treatment for ITS from 01/2004 to 05/2016 were studied. Preoperative and follow-up data were prospectively collected. Patients completed a standardized symptom questionnaire 1 year postoperatively and at 2-year intervals thereafter.

Results

In total, 235 patients were reviewed. The mean age was 70.0 ± 11.6 years; 174 patients (74.0%) were women. Surgical procedures included 7 transthoracic repairs and 228 transabdominal repairs (222 laparoscopic, 2 open, 4 laparoscopic-to-open conversions). Anti-reflux procedures were performed in 173 patients (73.6%). 33 patients (14.0%) had mesh reinforcement of hiatal closure; 11 (4.7%) underwent Collis gastroplasty. Follow-up symptom questionnaires at 1, 3, 5, 7, 9, and 11 years were available for 81, 48, 47, 30, 33, and 38% of patients, respectively. Significant and lasting symptom improvement was reported at all follow-up time points. Mean satisfaction scores of 9.3, 9.1, 9.3, 9.0, 9.5, and 9.8 on a 1–10 scale were recorded at the aforementioned intervals.

Conclusions

Long-term clinical outcomes confirm that laparoscopic ITS repair is safe and durable, and is associated with a high degree of patient satisfaction and symptom resolution.
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Literature
1.
go back to reference Sihvo E, Salo J, Rasanen J, Rantanen T (2009) Fatal complicatins of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg 137:419–424CrossRefPubMed Sihvo E, Salo J, Rasanen J, Rantanen T (2009) Fatal complicatins of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg 137:419–424CrossRefPubMed
2.
go back to reference Leeder P, Smith G, Dehn T (2003) Laparoscopic management of large para-esophageal hiatal hernias. Surg Endosc 17:1372–1375CrossRefPubMed Leeder P, Smith G, Dehn T (2003) Laparoscopic management of large para-esophageal hiatal hernias. Surg Endosc 17:1372–1375CrossRefPubMed
3.
go back to reference Yano F, Stadlhuber R, Tsuboi K, Gerhardt J, Filipi C, Mittal S (2009) Outcomes of surgical treatment of intra-thoracic stomach. Dis Esophagus 22(3):284–288CrossRefPubMed Yano F, Stadlhuber R, Tsuboi K, Gerhardt J, Filipi C, Mittal S (2009) Outcomes of surgical treatment of intra-thoracic stomach. Dis Esophagus 22(3):284–288CrossRefPubMed
4.
go back to reference Lidor A, Chang D, Feinberg R, Steele K, Schweitzer M, Franco M (2011) Morbidity and mortality associated with antireflux surgery with or without paraeophogeal hernia: a large ACS NSQIP analysis. Surg Endosc 25(9):3101–3108CrossRefPubMed Lidor A, Chang D, Feinberg R, Steele K, Schweitzer M, Franco M (2011) Morbidity and mortality associated with antireflux surgery with or without paraeophogeal hernia: a large ACS NSQIP analysis. Surg Endosc 25(9):3101–3108CrossRefPubMed
5.
go back to reference Cuschieri A, Shimi S, Nathanson L (1992) Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia. Am J Surg 163(4):425–430CrossRefPubMed Cuschieri A, Shimi S, Nathanson L (1992) Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia. Am J Surg 163(4):425–430CrossRefPubMed
6.
go back to reference Mittal SK, Bikhchandani J, Gurney O, Yano F, Lee T (2011) Outcomes after repair of the intrathoracic stomach: objective follow-up of up to 5 years. Surg Endosc 25:556–566CrossRefPubMed Mittal SK, Bikhchandani J, Gurney O, Yano F, Lee T (2011) Outcomes after repair of the intrathoracic stomach: objective follow-up of up to 5 years. Surg Endosc 25:556–566CrossRefPubMed
7.
go back to reference Targarona E, Grisales S, Uyanik O, Balague C, Pernas J, Trias M (2013) Long-term outcome and quality of life after laparoscopic treatment of large paraesophageal hernia. World J Surg 37(8):1878–1882CrossRefPubMed Targarona E, Grisales S, Uyanik O, Balague C, Pernas J, Trias M (2013) Long-term outcome and quality of life after laparoscopic treatment of large paraesophageal hernia. World J Surg 37(8):1878–1882CrossRefPubMed
8.
go back to reference Dallemagne B, Kohnen L, Perretta S, Weerts J, Markiewicz S, Jehaes C (2011) Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg 253(2):291–296CrossRefPubMed Dallemagne B, Kohnen L, Perretta S, Weerts J, Markiewicz S, Jehaes C (2011) Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg 253(2):291–296CrossRefPubMed
9.
go back to reference Hashemi M, Peters J, DeMeester T et al (2000) Laparoscopic repair of large type iii hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 190:553–560CrossRefPubMed Hashemi M, Peters J, DeMeester T et al (2000) Laparoscopic repair of large type iii hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 190:553–560CrossRefPubMed
10.
go back to reference Furnée E, Hazebroek E (2013) Mesh in laparoscopic large hiatal hernia repair: a systematic review of the literature. Surg Endosc 27(11):3998–4008CrossRefPubMed Furnée E, Hazebroek E (2013) Mesh in laparoscopic large hiatal hernia repair: a systematic review of the literature. Surg Endosc 27(11):3998–4008CrossRefPubMed
11.
go back to reference Draaisma W, Gooszen H, Tournoij E, Broeders I (2005) Controversies in paraesophageal hernia repair: a review of literature. Surg Endosc 19(10):1300–1308CrossRefPubMed Draaisma W, Gooszen H, Tournoij E, Broeders I (2005) Controversies in paraesophageal hernia repair: a review of literature. Surg Endosc 19(10):1300–1308CrossRefPubMed
12.
go back to reference Kelty C, Falk G (2007) The case against mesh repairs in hiatal surgery. Ann R Coll Surg Engl 89:479–481CrossRefPubMed Kelty C, Falk G (2007) The case against mesh repairs in hiatal surgery. Ann R Coll Surg Engl 89:479–481CrossRefPubMed
13.
go back to reference Svetanoff W, Pallati P, Nandipati K, Lee T, Mittal S (2016) Does the addition of fundoplication to repair the intra-thoracic stomach improve quality of life? Surg Endosc 30:4590–4597 Svetanoff W, Pallati P, Nandipati K, Lee T, Mittal S (2016) Does the addition of fundoplication to repair the intra-thoracic stomach improve quality of life? Surg Endosc 30:4590–4597
14.
go back to reference Mittal S (2014) Laparoscopic nissen fundoplication. In: Luketich JK LR, Pennathur A (eds) Master techniques in surgery: esophageal surgery. Wolters Kluwer Health, Philadelphia, pp 1–13 Mittal S (2014) Laparoscopic nissen fundoplication. In: Luketich JK LR, Pennathur A (eds) Master techniques in surgery: esophageal surgery. Wolters Kluwer Health, Philadelphia, pp 1–13
15.
go back to reference DeMeester SR (2013) Laparoscopic paraesophageal hernia repair: critical steps and adjunct techniques to minimize recurrence. Surg Laparosc Endosc Percutan Tech 23(5):429–435CrossRefPubMed DeMeester SR (2013) Laparoscopic paraesophageal hernia repair: critical steps and adjunct techniques to minimize recurrence. Surg Laparosc Endosc Percutan Tech 23(5):429–435CrossRefPubMed
16.
go back to reference Antonoff MB, D’Cunha J, Adrada RS, Maddaus MA (2012) Giant paraesophageal hernia repair: technical pearls. J Thorac Cardiovasc Surg 144(3):S67-S70CrossRef Antonoff MB, D’Cunha J, Adrada RS, Maddaus MA (2012) Giant paraesophageal hernia repair: technical pearls. J Thorac Cardiovasc Surg 144(3):S67-S70CrossRef
17.
go back to reference Korenkov M, Germer C, Lang H et al (2013) Individualisierte chirurgie des thoraxmagens und antirefluxchirurgie. Gastrointestinale operationen und technische varianten: Springer, Berlin; pp 37–86CrossRef Korenkov M, Germer C, Lang H et al (2013) Individualisierte chirurgie des thoraxmagens und antirefluxchirurgie. Gastrointestinale operationen und technische varianten: Springer, Berlin; pp 37–86CrossRef
18.
go back to reference Davies C (1975) A survey of the results of the boerema anterior gastropexy for hiatus hernia over a 4-year period. Br J Surg 62(1):19–22CrossRefPubMed Davies C (1975) A survey of the results of the boerema anterior gastropexy for hiatus hernia over a 4-year period. Br J Surg 62(1):19–22CrossRefPubMed
19.
go back to reference Boerema W (1969) Anterior gastropexy; a simple operation for hiatus hernia. Aust N Z J Surg 39(2):173–175CrossRefPubMed Boerema W (1969) Anterior gastropexy; a simple operation for hiatus hernia. Aust N Z J Surg 39(2):173–175CrossRefPubMed
20.
go back to reference Peet D, Klinkenberg-Knol E, Poza A, Sietses C, Eijsbouts Q (2000) MA C. Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment. Surg Endosc 14:1015–1018CrossRefPubMed Peet D, Klinkenberg-Knol E, Poza A, Sietses C, Eijsbouts Q (2000) MA C. Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment. Surg Endosc 14:1015–1018CrossRefPubMed
21.
go back to reference Lal D, Pellegrini C, Oelschlager B (2005) Laparoscopic repair of para-esophageal hernia. Surg Clin N Am 85:105–118CrossRefPubMed Lal D, Pellegrini C, Oelschlager B (2005) Laparoscopic repair of para-esophageal hernia. Surg Clin N Am 85:105–118CrossRefPubMed
22.
go back to reference Herbella F, Patti M, Del Grande J (2009) When did the esophagus start shrinking? The history of the short esophagus. Dis Esophagus 22:550–558CrossRefPubMed Herbella F, Patti M, Del Grande J (2009) When did the esophagus start shrinking? The history of the short esophagus. Dis Esophagus 22:550–558CrossRefPubMed
23.
go back to reference Orringer M, Sloan H (1977) Complications and failings of the combined collis-belsey operation. J Thorac Cardiovasc Surg 74:726–735PubMed Orringer M, Sloan H (1977) Complications and failings of the combined collis-belsey operation. J Thorac Cardiovasc Surg 74:726–735PubMed
24.
go back to reference Youssef Y, Shekar N, Lutfi R (2006) al e. Long-term evaluation of patient satisfaction and reflux symptoms after laparoscopic fundoplication with collis gastroplasty. Surg Endosc 20:1702–1705CrossRefPubMed Youssef Y, Shekar N, Lutfi R (2006) al e. Long-term evaluation of patient satisfaction and reflux symptoms after laparoscopic fundoplication with collis gastroplasty. Surg Endosc 20:1702–1705CrossRefPubMed
25.
go back to reference Garg N, Yano F, Filipi C, Mittal S (2009) Long-term symptomatic outcomes after collis gastroplasty with fundoplication. Dis Esophagus 22:532–538CrossRefPubMed Garg N, Yano F, Filipi C, Mittal S (2009) Long-term symptomatic outcomes after collis gastroplasty with fundoplication. Dis Esophagus 22:532–538CrossRefPubMed
26.
go back to reference Oelschlager B, Pellegrini C, Hunter J et al (2006) Biologic prosthesis reduces recurrence after laparoscopic para-esophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481–490PubMedPubMedCentral Oelschlager B, Pellegrini C, Hunter J et al (2006) Biologic prosthesis reduces recurrence after laparoscopic para-esophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481–490PubMedPubMedCentral
27.
go back to reference Frantzides C, Madan A, Carlson M, Stavropoulos G (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (ptfe) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137:649–652CrossRefPubMed Frantzides C, Madan A, Carlson M, Stavropoulos G (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (ptfe) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137:649–652CrossRefPubMed
28.
go back to reference Granderath F, Schweiger U, Kamolz T, Asche K, Pointner R (2005) Laparoscopic nissen fundoplication with prosthetic hiatal closure reduces postoperative intra-thoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140:40–48CrossRefPubMed Granderath F, Schweiger U, Kamolz T, Asche K, Pointner R (2005) Laparoscopic nissen fundoplication with prosthetic hiatal closure reduces postoperative intra-thoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140:40–48CrossRefPubMed
29.
go back to reference Stadlhuber R, Sherif A, Mittal S (2009) al e. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23:1219–1226CrossRefPubMed Stadlhuber R, Sherif A, Mittal S (2009) al e. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23:1219–1226CrossRefPubMed
30.
go back to reference Casabella F, Sinanan M, Horgan S, Pellegrini C (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 171(5):485–489CrossRefPubMed Casabella F, Sinanan M, Horgan S, Pellegrini C (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 171(5):485–489CrossRefPubMed
31.
go back to reference Williamson W, Ellis FJ, Streitz JJ, DM S (1993) Para-esophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 56(3):447–451CrossRefPubMed Williamson W, Ellis FJ, Streitz JJ, DM S (1993) Para-esophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 56(3):447–451CrossRefPubMed
32.
go back to reference Boeckxstaens G (2010) Alterations confined to teh gastro-oesophageal junction: the relationship between low losp, tlosrs, hiatus hernia, and acid pocket. Best Pract Res Clin Gastroenterol 81(8):821–829CrossRef Boeckxstaens G (2010) Alterations confined to teh gastro-oesophageal junction: the relationship between low losp, tlosrs, hiatus hernia, and acid pocket. Best Pract Res Clin Gastroenterol 81(8):821–829CrossRef
33.
go back to reference Swanstrom L, Jobe B, Kinzie L, Horvath K (1999) Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg 177:359–363CrossRefPubMed Swanstrom L, Jobe B, Kinzie L, Horvath K (1999) Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg 177:359–363CrossRefPubMed
34.
go back to reference Morris-Stiff G, Hassn A (2008) Laparoscopic paraoesophageal hernia repair: fundoplication is not usually indicated. Hernia 12(3):299–302CrossRefPubMed Morris-Stiff G, Hassn A (2008) Laparoscopic paraoesophageal hernia repair: fundoplication is not usually indicated. Hernia 12(3):299–302CrossRefPubMed
35.
go back to reference Geha A, Massad M, Snow N, Baue A (2000) A 32-year experience in 100 patients with giant paraesophageal hernia: the cse for abdominal approach and selective antireflux repair. Surgery 128(4):623–630CrossRefPubMed Geha A, Massad M, Snow N, Baue A (2000) A 32-year experience in 100 patients with giant paraesophageal hernia: the cse for abdominal approach and selective antireflux repair. Surgery 128(4):623–630CrossRefPubMed
36.
go back to reference Polomsky M, Hu R, Sepesi B et al (2010) A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach. Surg Endosc 24(6):1250–1255CrossRefPubMed Polomsky M, Hu R, Sepesi B et al (2010) A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach. Surg Endosc 24(6):1250–1255CrossRefPubMed
Metadata
Title
Long-term clinical outcomes after intrathoracic stomach surgery: a decade of longitudinal follow-up
Authors
Allison M. Blake
Sumeet K. Mittal
Publication date
01-04-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5890-5

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