title: Repair of giant paraesophageal hernias routinely produces improvement in respiratory function.
abstract: OBJECTIVE
  Assessment of the clinical impact of giant paraesophageal hernias have historically focused on upper gastrointestinal symptoms. This study assesses the effect of paraesophageal hernia repair on respiratory function.
  
  
  METHODS
  All patients undergoing repair of giant paraesophageal hernia were prospectively entered into a database approved by the institutional review board. Patients had symptoms documented preoperatively, including dyspnea. Pulmonary function tests (PFTs) were done preoperatively and repeated a median of 106 days after repair (range, 16-660 days).
  
  
  RESULTS
  Preoperative and postoperative PFTs were obtained in 120 unselected patients treated for paraesophageal hernia between 2000 and 2010. Patients' median age was 74 years (range, 45-91 years), 74 (62%) were female, and median body mass index was 28.0 (range, 16.8-46.6). Median length of stay was 4 days (range, 3-10 days), and perioperative mortality was zero. Hernias were classified as type II in 3 (3%) patients, III in 92 (77%), and IV in 25 (21%). Percent of intrathoracic stomach was assigned from preoperative contrast studies and grouped as less than 50% (n = 6; 5%), 50% to 74% (n = 35; 29%), 75% to 99% (n = 29; 24%), and 100% (n = 50; 42%). Preoperative symptoms included heartburn 71 (59%), early satiety 65 (54%), dyspnea 63 (52%), chest pain 48 (40%), dysphagia 56 (47%), regurgitation 47 (39%), and anemia 44 (37%). PFTs significantly improved after paraesophageal hernia repair (mean volume change, percent reference change): forced vital capacity +0.30 L,+10.3%pred; FEV(1) +0.23 L,+10.4%pred (all P < .001); diffusion capacity of the lung for carbon monoxide +0.58 mL · mm Hg(-1) · min(-1) (P = .004), and +2.9%pred (P = .002). Greater improvements were documented in older patients with significant subjective respiratory symptoms and higher percent of intrathoracic stomach (P < .01).
  
  
  CONCLUSIONS
  Paraesophageal hernia has a significant effect on respiratory function, which is largely underappreciated. This study demonstrates that these repairs can be done safely and supports routine consideration for elective repair; older patients with borderline respiratory function may achieve substantial improvements in their respiratory status and quality of life.
authors: Section of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA 98111, USA.
authors: Philip W
authors: PW
authors: Carrott
authors: Jean
authors: J
authors: Hong
authors: Madhankumar
authors: M
authors: Kuppusamy
authors: Steven
authors: S
authors: Kirtland
authors: Richard P
authors: RP
authors: Koehler
authors: Donald E
authors: DE
authors: Low
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006551:Hernia, Hiatal / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity; D020127:Recovery of Function; D012044:Regression Analysis; D012129:Respiratory Function Tests; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity; D014861:Washington