The Effect of Laparoscopic Paraesophageal Hernia Repair On Pulmonary Function Test

S Alnassar, J Kondra, J Clifion, R J Finley, S Kaaki. College of Medicine , King Saud University Riyadh , Saudi Arabia .Division of Thoracic Surgery, University of British Columbia, Vancouver, BC.

Objective: A retrospective cohort study was conducted to examine the impact of laparoscopic paraesophageal hernia repair on the pulmonary function test (PFT).

Methods: Between 2001 and 2005 there were 39 patients diagnosed with paraesophageal hernia. Patients were evaluated by history, physical examination, CXR, barium swallow and upper endoscopy. Pre-operative PFT was done within the 3 months prior to surgery and post-operative PFT was done at least 1 month after surgery.

Results: Thirty-four patients (87%, 8 males, 26 females) were included in the study with a mean age of 71y (±12y). Presenting symptoms included GERD (47.0%), dysphagia (35.2%), anemia (20.5%), dyspnea (32.4%), chest pain (61%), and cough (6%). Six patients had type II hernia; 22 had type III and 6 had type IV. The mean ASA was 2.5 (±0.7). Significant improvement was noted in mean FEVI (10.0%, pre: 2.17±0.78L, post: 2.38±0.92L, p=0.002), FVC (9.3%, pre: 3.01±1.05L, post: 3.27±1.22L p=0.001) and TLC (8.3%, pre: 5.95±1.59L, post: 6.43±1.49L, p=0.002). Improvements were also seen in FEVi/FVC% (2.0%, pre: 71.57±8.5%, post: 72.87±9.04%, p=0.166) and RV (7.8%, pre: 2.34±0.68L, post: 2.51±0.45L, p=0.123), however, they were not statistically significant. The mean length of stay was 2.6 days (±1.9). Minor post-operative complications occurred in 5 patients (14.7%). There was no in-hospital or 30-day mortality.

Conclusion: Laparoscopic repair of paraesophgeal hernia results in a significant improvement of PFT and is well tolerated by elderly patients with other comorbid diseases.

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