John M Glenn, DO, Edward Auyang, MD. University of New Mexico
Introduction: Little discussion of gastroparesis (GP) following laparoscopic paraesophageal hernia repair (LPHR) has been reported in the literature. We wished to examine the incidence in our institution, and identify potential risk factors for development of gastroparesis following LPHR.
Methods and Procedures: A single institution retrospective chart review was preformed using CPT codes corresponding to paraesophageal hernia repair and fundoplication to identify patients undergoing laparoscopic paraesophageal hernia repair over a five year period (1/1/2012 to 12/31/2016) by three surgeons. Emergency procedures and reoperations were excluded. In total, 93 patients undergoing non-emergent first time LPHRs were identified. Size of the hiatal defect was identified when able, via either measurement between the diaphragmatic crura on CT or by medical record documentation. Data obtained included sex, age, hernia type, mesh usage, and existence of specific comorbidities associated with gastroparesis. Presence of gastroparesis was identified either by documentation of diagnosis via clinical judgment, or by results of gastric emptying nuclear medicine studies, with timing being no longer than 6 months from date of surgery. Independent Students t-test and Fisher exact test were used to determine statistical differences between the groups.
Results: 93 patients undergoing non-emergent first time LPHRs were identified. Of these, we were able to obtain the size of the hiatal defect in 72 patients. 10 patients overall were diagnosed with gastroparesis, with an overall incidence of 11.0%. When comparing all patients who developed gastroparesis to those who did not, only females comprised the group which did develop gastroparesis (0 males/10 females with GP, 28 males/55 females without GP, p=0.029).
Age was also found to be greater in the group which developed gastroparesis. For patients in which the size of the hernia defect was identified, the average age was 9 years older in the group diagnosed with gastroparesis (67.0 +/- 9.34 with GP, 58.0 +/- 13.4 without GP, p=0.028). When including all patients for comparison, this difference approached statistical significance (67.0 +/- 9.34 with GP, 59.4 +/- 13.8 without GP, p=00.62)
No differences were found between the two groups in respect to size of hiatal defect, presence of mesh, smoking status, presence of diabetes mellitus, or chronic narcotic usage.
Conclusion: Our findings indicate that older age and female sex are risk factors for development of gastroparesis following LPHR. Our study is limited by small sample size, as well as lack of uniformity in measurement of the hiatal defect.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85692
Program Number: P425
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster