Repair of giant paraesophageal hernias routinely produces improvement in respiratory function

Abstract

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.

Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

“…Friction from the stomach moving in and out of the diaphragmatic hiatus can cause ulceration of the overlying gastric mucosa leading to upper gastrointestinal bleeding and chronic anaemia. The herniated stomach can also cause a mass effect in the posterior mediastinum leading to exertional dyspnea [35]. The annual risk of developing acute symptoms necessitating emergency surgery has been quoted as 1.1% per year [36].…”

“…In a number of cohort studies where patients were selected to have a GHH repair it has been reported that: 80% to 92% of preoperative symptoms resolve [2,40]; there is an improved gastro-intestinal quality of life [37,40,41]; there is an objective improvement in pulmonary function [35] and there is an objective improvecy towards a lower mean LOS pressure/tone, reduced LOS length and reduced intra-abdominal length of LOS contributing to the increased likelihood of GORD [22][23][24][25]28,30]. It is important to note that some patients with GHH have normal LOS pressures, which may explain why reflux is not always a major symptom in this group of patients [22,30].…”

“…Operative mortality in series from centres with an interest in the disease is reported to be 0% to 2%, with operative morbidity between 13% to 16% [1,3,35,37]. Conversion to an open approach has been reported to be 0% to 7.5% [1,3,37].…”

“…Conversion to an open approach has been reported to be 0% to 7.5% [1,3,37]. The median hospital stay is 2 to 4 days [1,3,35]. Open repair is still advocated in some centres with one group suggesting a lower long-term recurrence rate [2,19,35,38].…”

“…The median hospital stay is 2 to 4 days [1,3,35]. Open repair is still advocated in some centres with one group suggesting a lower long-term recurrence rate [2,19,35,38]. A recent series of 270 patients who underwent open repair reported no post-operative mortality, but post-operative morbidity was 38% and the median length of stay 4 days [2].…”