Introduction: This study is to examine the impact of laparoscopic repair of large hiatal hernia on patient’s respiratory function and quality of life.
Methods: From 2004 to 2008, 30 consecutive patients with large paraesophageal hernia defined as >50% of stomach in the intrathoracic cavity with a minimum follow-up of 2 years were included in this study. All patients graded theirdyspnoea severity asan index of 1=no dyspnoea, 2=dyspnoea with exertion, 3=dyspnoea with basic activities or 4=dyspnoea at rest. All patients had a formal respiratory function test 1 week prior and 3 months after their laparoscopic hiatal hernia repair. The patients had to rate their symptom severity and complete a quality of life questionnaire in the form of Gastrointestinal Quality of Life Index (GIQLI) preoperatively and then at 3-month, 6-month and thereafter yearly intervals postoperatively.
Results: There were no hospital mortality and the morbidity rate was 10%. In 26 patients with preoperative dyspnoea, 22 had complete resolution while the remaining 4 had experienced improvement in dyspnoea severity postoperatively. The mean dyspnoea severity index reduced from 2.4 to 1.3(p<0.001). Overall, there was 1%, 3% and 3% postoperative increase in FEV1, FVC and DLCO values for the whole group, none of which reached statistical significance. For the patients with resolution or improvement of their dyspnoea after the laparoscopic repair, no significant changes in their respiratory function parameters were demonstrated. The GIQLI score improved from a preoperative value of 85.7 to 107.9 postoperatively(p<0.001).
Table 1. Symptom outcomes (SI – Severity Index)
| Symptoms |
Preop No. of Patients |
Postop No. of Patients | Preop SI Mean | Postop SI Mean |
P Value |
| Heart burn | 18 (60%) | 5(16%) | 2.2 | 1.3 | P<0.001 |
| Chest pain | 16 (53%) | 2 (3%) | 2.0 | 1.1 | P=0.001 |
| Dysphagia | 15 (50%) | 2 (7%) | 2.1 | 1.1 | P=0.001 |
| Regurgitation | 10 (33%) | 1 (3%) | 1.7 | 1.0 | P=0.008 |
| Dyspnoea | 26(87%) | 4 (13%) | 2.4 | 1.3 | P<0.001 |
Table 2. Preoperative and postoperative FEV1, FVC and DLCO values for the 30 patients with large hiatal hernias
| Variables | Preop Mean | Postop Mean | % improvment | P Value |
| FEV1 (Liters) | 2.03 | 2.08 | 1% | P=0.148 |
| FVC (Liters) | 2.6 | 2.7 | 3% | P=0.121 |
|
DLCO (mL/mmHg/min) |
18.0 | 18.6 | 3% | P=0.264 |
Table 3. Preoperative and postoperative FEV1, FVC and DLCO values for the 30 patients divided into 3 groups according to their dyspnoea response (n=number)
| Variables | Preop Mean | Postop Mean | % Improvement | P Value |
| Patients with no initial dyspnoea (n=4) | ||||
| FEV1 (Liters) | 2.25 | 2.3 | 2% | P=0.287 |
| FVC (Liters) | 2.65 | 2.75 | 4% | P=0.187 |
| DLCO (mL/mmHg/min) | 21.3 | 20.4 | -4% | P=0.465 |
| Patient with dyspnoea improved (n=4) | ||||
| FEV1 (Liters) | 1.81 | 1.81 | 0% | P=0.670 |
| FVC (Liters) | 2.1 | 2.2 | 4% | P=0.114 |
| DLCO (mL/mmHg/min) | 15.7 | 16.3 | 4% | P=0.439 |
| Paitents with dyspnoea resolved (n=22) | ||||
| FEV1 (Liters) | 2.05 | 2.12 | 2% | P=0.441 |
| FVC (Liters) | 2.54 | 2.62 | 4% | P=0.09 |
| DLCO (mL/mmHg/min) | 19.2 | 20.1 | 3% | P=0.537 |
Conclusions: We failed to show a significant change in patient’s respiratory function despite a clearly demonstrated improvement of their respiratory symptoms. Alternative reasons for the reduction of dyspnoea severity should be sought. Laparoscopic hernia repair is also a safe procedure that can lead to better patient quality of life.
Session: Podium Presentation
Program Number: S078