Rajmohan Rammohan, MD, Kotaro Wakamatsu, MD, Phd, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida
Background: Achalasia is often associated with hiatal hernias. It is unknown if this plays a role in the overall outcomes. We present our 5-year experience of laparoscopic Heller myotomies (LHM).
Methods: Records of patients who underwent LHM from 2010 to 2015 were retrospectively reviewed.When the hiatal hernia was present, unidirectional barbed suture was used to close the defect.These outcomes were compared between group with Quillclosure (QC) and NoClosure.
Results: One hundred seven patients were identified.There were 56 male patients (52.3%) with an average age of 58±17.There were 27(25%) patients underwent with Quill closure.The QC group presented longer operation time (86±29 min vs 71± 25.1 min, p=0.01)andhigher complication rate (10% vs0 %, p<0.01) than No closure.Closure and No closure, blood loss (27 ±34ml vs 31 ±32 ml), hospital stay length(3.2±2.7 day’s vs 2.3± 2.5days,)and 30-days readmission rate(13.7% vs 3.8%)wer comparable between the groups.However,Closure indicated.After the surgery,there was lesser improvement of dysphagia in Closure than in No closure(17%vs5.1% p= 0.04),with medianfollow-up 1.4year
Conclusion: LaparoscopicMyotomy with fundoplication and hiatal closure yields reasonable early clinical outcomes.However,this study revealsachalasia patients with hiatal hernia constitutes different clinical entity in terms of worse complication rate and worse improvement rate of major symptom than the patients without hiatalhernia.
| Closure | NO Closure | Combine | ||
| n=27 | n=78 | n=107 | p-values | |
| Preoperation | ||||
| Dysphagia | 26(89.6%) | 69(88.4%) | 95(88.7%) | |
| Regurgitation | 13(44.8%) | 16(20.5%) | 29(27.1%) | p=0.01 |
| Nausea/vomitting | 6(20.6%) | 9(11.5%) | 15(14%) | |
| Chestpain | 2(6.8%) | 5(6.4%) | 7(6.5%) | |
| Heartburn | 5(17.2%) | 11(14.1%) | 16(14.9%) | |
| Weightloss | 11(37.9%) | 10(12.8%) | 21(19.6%) | p=0.03 |
| PPI usage | 14(48.2%) | 38(48.7%) | 52(48.5%) | |
| Postoperation | ||||
| Dysphagia | 5(17.2%) | 4(5.1%) | 9(8.4%) | p=0.04 |
| Regurgitation | 3(10.3%) | 4(5.1%) | 7(6.5%) | |
| Nausea/vomiting | 1(3.4%) | 1(1.2%) | 1(1%) | |
| Chestpain | 0 | 0 | 0 | |
| Heartburn | 1(3.4%) | 3(3.8%) | 4(3.7%) | |
| Weightloss | 2(6.8%) | 0(10%) | 2(1.8%) | |
| PPIusage | 13(44.8%) | 39(50%) | 52(48.5%) |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78923
Program Number: P633
Presentation Session: Poster (Non CME)
Presentation Type: Poster
