Subjective outcome after laparoscopic hiatal hernia repair for intrathoracic stomach

Abstract

PurposeFor decades, an intrathoracic stomach (ITS) has been a definite indication for surgery due to the perceived risk of an acute volvulus with perforation, gangrene, or hemorrhage. At the present time, elective laparoscopic repair is the first choice for treatment of ITS. There is a lack of evidence in the long-term quality of life after a hiatal hernia repair for an intrathoracic stomach.MethodsA retrospective analysis was performed on all patients undergoing a hiatal hernia repair for an intrathoracic stomach between January 2004 and January 2015. Additionally, to a hiatal closure, the patients received an antireflux procedure. Outcome measures included patient characteristics, operative details, complications, and postoperative morbidity and mortality. All patients were sent a quality of life questionnaire to assess long-term quality of life and patient satisfaction. A higher quality of life score represents a better quality of life.ResultsEighty-six patients underwent laparoscopic repair for ITS, from which, one patient died during surgery. Eighty-five patients were contacted and 81 completed the questionnaire, resulting in a response rate of 95.3 %. At a median follow-up of 2.7 years (range 0.1–9.6), the mean quality of life score was 13.5 (standard deviation 2.8). The mean overall satisfaction was 8.4.There were four recurrences: three in the first 12 days after surgery and one in 2.4 years.ConclusionsVery good results in patient satisfaction and symptom reduction were achieved after a median follow-up of 2.7 years in this laparoscopic repair of the intrathoracic stomach single center experience study. The symptomatic recurrence rate was very low.

Delayed Gastric Emptying Following Laparoscopic Repair of Very Large Hiatus Hernias Impairs Quality of Life

“…Since the advent of laparoscopic hiatus hernia surgery in the 1990s [11, 21, 22], multiple studies have demonstrated that this technique effectively treats upper gastrointestinal symptoms secondary to the hiatus hernia and the underlying reflux disease [6, 23, 24]. In the light of these studies, our findings are clinically important, as we have now identified a significant subgroup of patients who do not derive the maximum benefit from their hiatus hernia surgery.…”

Paraoesophageal Hernias: A Surgical Perspective

“…The same UK study concluded that the rate of recurrence was significantly lower when oesophageal lengthening by means of Collis gastroplasty was performed [23]. Another recent study on Type III paraoesophageal hernias from the Netherlands, where laparoscopic closure of the hiatus was always combined with an anti-reflux procedure, showed a very low of less than 5% symptomatic recurrence rate, after about 3 years median follow up [24].…”

Large hiatus hernia: time for a paradigm shift?

“…He succumbed to a fatal gastropleural fistula 2 months later [49]. Thirdly they could occur intraoperatively from aortic injury especially due to adhesions and anatomical distortion caused by the LHH [61]. They are fortunately a rare occurrence.…”

“…Watson [54] declared two perforations, one from a bougie the other was noted on the third postoperative day. Casteljins reported an intraoperative esophageal perforation that required stenting, with subsequent need for resection and conduit formation [61]. Luckily those complications are not very common.…”