John R Stringham1, Jennifer V Phillips1, Timothy L McMurry2, Drew L Lambert3, David R Jones4, James M Isbell4, Christine L Lau1, Benjamin D Kozower5. 1. Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Va. 2. Division of Public Health Sciences, University of Virginia Health Sciences Center, Charlottesville, Va. 3. Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, Va. 4. Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 5. Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo. Electronic address: kozowerb@wudosis.wustl.edu.
Abstract
OBJECTIVE: Evaluating giant paraesophageal hernia (GPEH) repair requires long-term follow-up. GPEH repair can have associated high recurrence rates, yet this incidence depends on how recurrence is defined. Our objective was to prospectively evaluate patients undergoing GPEH repair with 1-year follow-up. METHODS: Patients undergoing elective GPEH repair between 2011 and 2014 were enrolled prospectively. Postoperatively, patients were evaluated at 1 month and 1 year. Radiographic recurrence was evaluated by barium swallow and defined as a gastroesophageal junction located above the hiatus. Quality of life was evaluated pre- and postoperatively with the use of a validated questionnaire. RESULTS: One-hundred six patients were enrolled. The majority of GPEH repairs were performed laparoscopically (80.2%), and 7.5% were redo repairs. At 1-year follow-up, 63.4% of patients were symptom free, and radiographic recurrence was 32.7%. Recurrence rate was 18.8% with standard definition (>2 cm of stomach above the diaphragm). Quality of life scores at 1 year were significantly better after operative repair, even in patients with radiographic recurrence (7.0 vs 22.5 all patients, 13.0 vs 22.5 with recurrence; P < .001). Patients with small radiographic recurrences have similar satisfaction and symptom severity to patients with >2 cm recurrences. CONCLUSIONS: GPEH repair can be performed with low operative mortality and morbidity. The rate of recurrence at 1 year depends on the definition used. Patient satisfaction and symptom severity are similar between patients with radiographic and greater than 2 cm hernia recurrences. Longer follow-up and critical assessment of our results are needed to understand the true impact of this procedure and better inform perioperative decision making.
OBJECTIVE: Evaluating giant paraesophageal hernia (GPEH) repair requires long-term follow-up. GPEH repair can have associated high recurrence rates, yet this incidence depends on how recurrence is defined. Our objective was to prospectively evaluate patients undergoing GPEH repair with 1-year follow-up. METHODS:Patients undergoing elective GPEH repair between 2011 and 2014 were enrolled prospectively. Postoperatively, patients were evaluated at 1 month and 1 year. Radiographic recurrence was evaluated by barium swallow and defined as a gastroesophageal junction located above the hiatus. Quality of life was evaluated pre- and postoperatively with the use of a validated questionnaire. RESULTS: One-hundred six patients were enrolled. The majority of GPEH repairs were performed laparoscopically (80.2%), and 7.5% were redo repairs. At 1-year follow-up, 63.4% of patients were symptom free, and radiographic recurrence was 32.7%. Recurrence rate was 18.8% with standard definition (>2 cm of stomach above the diaphragm). Quality of life scores at 1 year were significantly better after operative repair, even in patients with radiographic recurrence (7.0 vs 22.5 all patients, 13.0 vs 22.5 with recurrence; P < .001). Patients with small radiographic recurrences have similar satisfaction and symptom severity to patients with >2 cm recurrences. CONCLUSIONS:GPEH repair can be performed with low operative mortality and morbidity. The rate of recurrence at 1 year depends on the definition used. Patient satisfaction and symptom severity are similar between patients with radiographic and greater than 2 cm hernia recurrences. Longer follow-up and critical assessment of our results are needed to understand the true impact of this procedure and better inform perioperative decision making.
Authors: M Hashemi; J H Peters; T R DeMeester; J E Huprich; M Quek; J A Hagen; P F Crookes; J Theisen; S R DeMeester; L F Sillin; C G Bremner Journal: J Am Coll Surg Date: 2000-05 Impact factor: 6.113
Authors: Brant K Oelschlager; Rebecca P Petersen; L Michael Brunt; Nathaniel J Soper; Brett C Sheppard; Lee Mitsumori; Charles Rohrmann; Lee L Swanstrom; Carlos A Pellegrini Journal: J Gastrointest Surg Date: 2012-01-04 Impact factor: 3.452
Authors: Brant K Oelschlager; Carlos A Pellegrini; John Hunter; Nathaniel Soper; Michael Brunt; Brett Sheppard; Blair Jobe; Nayak Polissar; Lee Mitsumori; James Nelson; L Swanstrom Journal: Ann Surg Date: 2006-10 Impact factor: 12.969
Authors: Blair A Jobe; Ralph W Aye; Clifford W Deveney; John S Domreis; Lucius D Hill Journal: J Gastrointest Surg Date: 2002 Mar-Apr Impact factor: 3.452
Authors: Andrew F Pierre; James D Luketich; Hiran C Fernando; Neil A Christie; Percival O Buenaventura; Virginia R Litle; Philip R Schauer Journal: Ann Thorac Surg Date: 2002-12 Impact factor: 4.330
Authors: James D Luketich; Katie S Nason; Neil A Christie; Arjun Pennathur; Blair A Jobe; Rodney J Landreneau; Matthew J Schuchert Journal: J Thorac Cardiovasc Surg Date: 2009-12-11 Impact factor: 5.209
Authors: Himanshu J Patel; Bethany B Tan; John Yee; Mark B Orringer; Mark D Iannettoni Journal: J Thorac Cardiovasc Surg Date: 2004-03 Impact factor: 5.209
Authors: Henriikka Hietaniemi; Ilkka Ilonen; Tommi Järvinen; Juha Kauppi; Saana Andersson; Harri Sintonen; Jari Räsänen Journal: BMC Surg Date: 2020-05-20 Impact factor: 2.102
Authors: Akshay R Date; Yan Mei Goh; Yan Li Goh; Ilayaraja Rajendran; Ravindra S Date Journal: J Minim Access Surg Date: 2021 Oct-Dec Impact factor: 1.407