John E Wennergren, MD, Salomon Levy, MD, Curtis Bower, MD, Michael T Miller, Daniel L Davenport, PhD, Margaret Plymale, MSN, RN, John Scott Roth, MD. University of Kentucky
Introduction: Redo paraesophageal hernia repair is uncommonly performed for recurrent hiatal hernia and/or reflux with little understanding as to outcomes related to perioperative and subjective patient variables. The aim of this study is to understand what differences exist between patients undergoing initial paraesophageal hernia repair (IPEH) and those undergoing redo paraesophageal repair (RPEH).
Methods: A review of all PEH repairs between 2009 and 2013 was performed from a single institution. RPEH patients were identified and analyzed for demographic information, perioperative/intraoperative details and postoperative outcomes. A similar comparison group of IPEH patient’s was then randomly selected from the same sample as a control. A phone questionnaire was administered to the RPEH group.
Results: Amongst 336 total PEH repairs from 2009 to 2013, 40 RPEH patients were identified. A matched cohort of 76 patients was identified. RPEH and IPEH groups had similar DeMeester score, incidence of Barrett’s esophagus (BE), % requiring a PEG, LOS, readmission rate, mortality and recurrence rates. Operative times (163 vs 209 min, p<0.001), incidence of Collis gastroplasty (1% vs. 20%, p<0.001) and EBL >10cc (21% vs 50%, p<0.009) differed between IPEH and RPEH respectively.
48% of RPEH completed a follow up questionnaire with overall satisfaction among this group (1-5scale) being 89% with five representing completely satisfied. Recurrent symptoms included chest pain (37%), solid dysphagia (42%), nausea (58%), vomiting (32%), bloating (63%) and hoarseness (21%). 21% of patients required antacid medications.
Conclusion: Recurrent PEH repair is performed with similar outcomes to IPEH with the exception of increased operative time and bleeding. Collis gastroplasty is required more frequently in RPEH patients. Persistent symptoms exist following RPEH repair. Despite symptomatology, patient satisfaction is high. RPEH may be safely performed in patients with recurrent paraesphageal hernias with outcomes similar to primary PEH repairs.