title: The effect of diaphragmatic stressors on recurrent hiatal hernia.
abstract: Hiatal disruption is one of the common mechanisms of failure after Nissen fundoplication. We investigated the correlation between various diaphragm stressors and disruption of the diaphragmatic closure. Thirty-seven patients with a hiatal hernia recurrence of 2 cm or greater, as proven by esophagram, endoscopy, or operative findings, were included. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire for the study group and a control group of 50 patients without hiatal hernia recurrence. Logistic regression was used to determine the significant predictors of hiatal hernia recurrence. Three predictors emerged in the final model: weight lifting (P < 0.0174), vomiting (P < 0.0313) and hiccoughing (P < 0.2472). Of these, only vomiting and weight lifting were significant. The odds ratio for weight lifting is OR = 3.662 (95% CI: 1.256-10.676), and for vomiting it is OR = 4.938 (95% CI: 1.154-21.126). Vomiting or heavy weight lifting is a significant predictor of hiatal hernia recurrence.
authors.affiliation: Department of Surgery, Suite 3740, Creighton University School of Medicine, 601 N 30th Street, Omaha, NE 68131-2197, USA.
authors.forename: G V
authors.initials: GV
authors.lastname: Kakarlapudi
authors.forename: Z T
authors.initials: ZT
authors.lastname: Awad
authors.forename: G
authors.initials: G
authors.lastname: Haynatzki
authors.forename: T
authors.initials: T
authors.lastname: Sampson
authors.forename: G
authors.initials: G
authors.lastname: Stroup
authors.forename: C J
authors.initials: CJ
authors.lastname: Filipi
mesh_terms: D034841:Abdominal Cavity / Q000503:physiopathology; D003964:Diaphragm / Q000503:physiopathology; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D011312:Pressure; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014839:Vomiting; D014891:Weight Lifting