Sreeja Biswas Roy, MBBS1, Michael T Olson1, Paul Kang, MPH2, Roshan Panchanathan, BS1, Taylor Ipsen, BS1, Sumeet K Mittal, MD1, Jasmine Huang, MD1, Michael A Smith, MD1, Ross M Bremner, MD, PhD1. 1Norton Thoracic Institute, 2University of Arizona College of Public Health-Phoenix
INTRODUCTION: Surgical intervention remains the optimal treatment for patients with paraesophageal hiatal hernia (PEH). In this study, we analyzed intermediate term (at least two-year) symptomatic outcomes and need for surgical reintervention, after primary repair with onlay mesh, of PEH to determine whether these variables correlate with body mass index (BMI).
METHODS AND PROCEDURES: We retrospectively reviewed 378 patients who underwent primary PEH repair with onlay absorbable mesh, without Collis gastroplasty, at our center from 05/28/2009 to 12/31/2013. Patients were organized into groups based upon preoperative BMI: A (BMI ≥35), B (BMI 30-34.9), C (BMI 25-29.9), and D (BMI <25). We administered a standardized, 5-point-scale survey for patients to report symptoms (0=no symptoms, 5=worst experienced) and satisfaction with surgical outcomes.
RESULTS: In total, 378 patients underwent primary PEH repair during the study period. The mean age was 59.6±13.3 years, and 250 patients (66%) were female. The mean BMI of the entire cohort was 29.9±4.9. Group A included 63 patients (17%), Group B had 110 (29%), Group C had 155 (41%), and Group D had 50 (13%). All patients had primary repair without Collis gastroplasty, and an antireflux procedure was performed in 376 patients (205 Nissen, 167 Toupet, 4 Dor). Acid suppressants were discontinued within 2-4 weeks of surgery in 300/378 patients (79%; p<0.001). 218 patients (57%) were available for a mean follow-up of 52.3±13.8 months. Mean symptom survey scores were 0.7±1.1 for heartburn, 0.4±1.2 for dysphagia, 0.4±1.0 for regurgitation, and 0.5±1.1 for chest or epigastric pain. At intermediate follow-up, 24/218 patients required reoperation, and the probability of surgical reintervention did not vary based on BMI (Figure; p=0.64). In total, 176/197 (89%) patients reported satisfaction with their PEH repair, and no difference in satisfaction existed among BMI groups.
CONCLUSION: Clinical outcomes after primary repair of PEH with onlay absorbable mesh are excellent. The need for surgical reintervention does not appear to be related to pre-operative BMI.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79834
Program Number: P372
Presentation Session: Poster (Non CME)
Presentation Type: Poster