title: Laparoscopic repair of large paraesophageal hiatus hernia: quality of life and durability.
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.
  
  
  CONCLUSIONS
  Laparoscopic repair of LPOHH is associated with good quality of life as well as an acceptable midterm recurrence rate.
authors.affiliation: Shropshire Upper Gastrointestinal and Laparoscopic Surgery Unit, The Princess Royal Hospital, Apley Castle, Telford, Shropshire, United Kingdom, TF1 6TF. drrajeev_p@yahoo.com
authors.forename: R
authors.initials: R
authors.lastname: Parameswaran
authors.forename: A
authors.initials: A
authors.lastname: Ali
authors.forename: S
authors.initials: S
authors.lastname: Velmurugan
authors.forename: S E
authors.initials: SE
authors.lastname: Adjepong
authors.forename: A
authors.initials: A
authors.lastname: Sigurdsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000503:physiopathology; D006304:Health Status; D006551:Hernia, Hiatal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D012008:Recurrence; D011795:Surveys and Questionnaires