Michael A Antiporda, MD1, Benjamin Veenstra, MD2, Chloe Jackson1, C D Smith, MD3, Steven P Bowers, MD1. 1Mayo Clinic Florida, 2Rush University Medical Center, 3Piedmont Hospital, Atlanta GA
INTRODUCTION: Repair of giant paraesophageal hernia (PEH) is associated with a favorably high rate of improvement in symptoms. However, rates of recurrence by objective measures remain high as well. Herein we analyze our experience with laparoscopic giant PEH repair to determine what factors if any can predict anatomic recurrence.
METHODS AND PROCEDURES: We prospectively collected data on PEH characteristics, variations in techniques of operative repair, and surgeon factors for 595 patients undergoing laparoscopic PEH repair from 2008 to 2015. Upper GI study was performed at six months post-operatively per protocol and thereafter on a selective basis. Exclusion criteria included revisional operation (22.4%), size smaller than 5 cm (17.6%), inadequate follow-up (17.8%), and confounding concurrent operations (6.9%). Out of 595 patients, 201 patients met inclusion criteria. This population was 32% male with a mean age of 69 years and BMI of 28.7, and were followed for a mean of 11.5 months (range 3-72). Univariate statistical analysis was performed using two-tailed Student’s t-test and Fisher’s exact test.
RESULTS: Overall anatomic recurrence rate of paraesophageal hernia was 33.3%. Re-operation was required in 4 of the anatomic recurrence group, while 1 of the non-recurrence group underwent re-operation for severe dysphagia. The overall rate of recurrence of symptoms or development of dysphagia was 7.8%. PEH characteristics (size, presence of Cameron erosions, esophagitis, or Barrett’s) did not correlate with anatomic recurrence. Technical factors at operation (mobilized intra-abdominal length of esophagus, performance of Collis gastroplasty, number of anterior and posterior stitches, use of crural buttress, use of pledgeted or mattress sutures, or gastrostomy) also were not associated with differences in anatomic recurrence rates. Regarding surgeon factors, annual volume of fewer than 10 cases per year was associated with an increased risk of anatomic failure (54% vs. 33%, P = 0.02).
CONCLUSIONS: Laparoscopic repair of giant paraesophageal hernias is associated with high anatomic recurrence rate but an excellent rate of symptom control. PEH characteristics and technical operative variables do not appear to significantly affect rates of recurrence. In contrast, individual surgeon factors do appear to contribute to the durability of repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79973
Program Number: S143
Presentation Session: Plenary 2
Presentation Type: Podium