title: Defining recurrence after paraesophageal hernia repair: correlating symptoms and radiographic findings.
abstract: BACKGROUND
  Laparoscopic repair of paraesophageal hernia (PEH) has been shown to result in excellent relief of symptoms and improved quality of life (QOL) despite a high radiographically identified recurrence rate. Because there is no uniform definition of PEH recurrence, it is difficult to compare studies reporting on this. This study attempts to introduce consistency to the definition of PEH recurrence based on correlation of symptoms and radiographic findings.
  
  
  METHODS
  This is an analysis of data derived from an ongoing prospective study. From April 2009 to December 2012, we enrolled 101 patients who underwent elective laparoscopic PEH repair with bioprosthesis buttressed over a primary cruroplasty. A validated gastroesophageal reflux disease-specific QOL tool was administered to patients before, and at 2 and 12 months postoperatively. Upper gastrointestinal barium contrast examination (UGI) was performed at 1 year.
  
  
  RESULTS
  Of 101 patients, 13 were not available for follow-up, 58 reached the 1-year milestone for interval UGI, and 1 patient required reoperation for symptomatic recurrent PEH. There was no relationship between total QOL score and radiographic recurrent hernia (RRH); however, significant deterioration in many symptoms was seen in RRH > 2 cm. Based on these findings, we defined recurrence as RRH > 2 cm and calculated our recurrence rate as 28% (n = 16).
  
  
  CONCLUSIONS
  Our analysis of symptom scores after laparoscopic PEH repair suggests that significant worsening occurs with RRH > 2 cm. Given that there is no consistent description of recurrent PEH, we suggest this as a possible standardized definition. Overall, patients with recurrent PEHs continue to experience excellent QOL and rarely require reoperation.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. alidor1@jhmi.edu
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
authors.forename: Qingwen
authors.initials: Q
authors.lastname: Kawaji
authors.forename: Miloslawa
authors.initials: M
authors.lastname: Stem
authors.forename: Richard M
authors.initials: RM
authors.lastname: Fleming
authors.forename: Michael A
authors.initials: MA
authors.lastname: Schweitzer
authors.forename: Kimberley E
authors.initials: KE
authors.lastname: Steele
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marohn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging* / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D012008:Recurrence; D012086:Reoperation