Laparoscopic repair of giant paraesophageal hernia results in long-term patient satisfaction and a durable repair.
BACKGROUND
Laparoscopic repair of giant paraesophageal hernia (LRGPEH) is routinely performed in many centers, but high recurrence rates have led to concerns regarding this approach. We evaluate long-term recurrence rates, symptom improvement and correlation with radiographic recurrence, and risk factors for recurrence in our cohort of patients.


METHODS
A cohort of consecutive patients with a minimum of 5 years potential follow-up (1997-2003) post-LRGPEH was identified from a prospective database. Clinical outcomes, barium esophagram (BE), and quality-of-life (QoL) measures were obtained.


RESULTS
Laparoscopic repair was successful in 185/187 patients. Routine clinical follow-up (median 77 months) was available for all patients. Detailed questionnaires and BE were obtained in 65% and 82% of patients. Gastroesophageal Reflux Disease Health-Related QoL (GERD-HRQoL) scores were excellent to good in 86.7%. BE (median 51 months) demonstrated radiographic hernia recurrence in 15% of patients, but without consistent symptom association. There was a trend toward increased risk of radiographic recurrence in patients with a history of pulmonary disease (p = 0.08). Seven reoperations (4.4%) were performed for symptomatic recurrence (median 44 months postoperative).


CONCLUSIONS
LRGPEH performed in our minimally invasive center of excellence resulted in a durable repair with a high degree of satisfaction and preservation of GERD-related QoL at a median follow-up of over 6 years.
Nason
Katie S
KS
Division of Thoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. nasonks@upmc.edu
Luketich
James D
JD
Qureshi
Irfan
I
Keeley
Samuel
S
Trainor
Shannon
S
Awais
Omar
O
Shende
Manisha
M
Landreneau
Rodney J
RJ
Jobe
Blair A
BA
Pennathur
Arjun
A
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D012008:Recurrence; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome