Laparoscopic paraesophageal hernia repair: defining long-term clinical and anatomic outcomes.
OBJECTIVE
We recently reported in a multi-institutional, randomized study of laparoscopic paraesophageal hernia repair (LPEHR) that the anatomic recurrence rate at a median of approximately 5 years was >50%. This study focuses exclusively on the symptomatic response to LPEHR and its relationship with the development of a recurrent hernia.


METHODS
During 2002 to 2005, 108 patients underwent LPHER with or without biologic mesh. A standardized symptom severity questionnaire, SF-36 health survey, and upper gastrointestinal series were performed at baseline, 6 months, and during 2008-2009.


RESULTS
Of 108 patients, 72 (average age of 68 ± 10 years) underwent clinical assessment, and 60 of them also had radiologic studies at a median follow-up of 58 (40-78) months. Radiographic recurrence (≥ 20 mm) was 14% at 6 months and 57% at the time of follow-up, and the average recurrence size was 40 ± 10 mm. All symptoms were significantly improved at long-term follow-up and, with the exception of heartburn, were unaffected by the presence or size of the recurrence. Two patients (3%) with recurrent symptoms related to their hernia underwent reoperation.


CONCLUSIONS
Despite frequent radiologic recurrences after LPEHR, symptoms remain well controlled, patient satisfaction is high, and the need for reoperation is low.
Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195-6410, USA. brant@u.washington.edu
Brant K
BK
Oelschlager
Rebecca P
RP
Petersen
L Michael
LM
Brunt
Nathaniel J
NJ
Soper
Brett C
BC
Sheppard
Lee
L
Mitsumori
Charles
C
Rohrmann
Lee L
LL
Swanstrom
Carlos A
CA
Pellegrini
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome