Ahmed M Zihni, MD, MPH, Christy M Dunst, MD, Walaa F Abdelmoaty, MD, MBA, Filippo Filicori, MD, Rosen Ilchev, BS, Daniel Davila-Bradley, MD, Kevin Reavis, MD, Lee Swanstrom, MD, Steven R DeMeester, MD. The Oregon Clinic
Introduction: Paraesophageal hernia repairs are increasing in prevalence, and unfortunately carry a high recurrence rate. Consequently, reoperation is expected to increase in frequency. Published data on the outcomes of recurrent paraesophageal hernia (RPEH) repair is very limited. Because of the technical difficulties of revisional surgery, we hypothesize that laparoscopic revisional paraesophageal hernia repairs are associated with high perioperative morbidity and poor patient outcomes.
Methods: All RPEH repairs performed by the foregut surgical service at our institution from 2012 to 2015 were reviewed. Patients were included if their index operation was a true PEHR (initial type 1 hiatal hernia repairs were excluded, as well as multiply recurrent hernias). Demographics, medical and surgical history, and operative notes from the index surgery were reviewed. Details from standardized pre-operative symptom assessment, objective testing and operative details for the revisional surgery were collected. Patients were routinely offered 12 month post-operative upper gastrointestinal contrast evaluation. Postoperative outcomes included a standardized symptom assessment and results of objective testing at any time after surgery.
Results: Twenty six patients were identified who underwent repair of RPEH. Demographic, operative and perioperative data was available for all patients (Table 1). Twenty four patients underwent follow-up symptom evaluation (two were lost to follow-up after the initial hospitalization). Sixteen patients underwent follow-up objective testing by radiographic evaluation with contrast, endoscopy or both. These subgroups were used to calculate symptomatic and objective outcomes (Table 1).
Conclusion: Reoperative laparoscopic surgery for recurrent paraesophageal hernias is technically challenging as evidenced by long operative times. Despite this, perioperative outcomes at a high volume center are good, with low morbidity and no mortality. Importantly, symptomatic outcomes for this difficult problem are excellent.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87260
Program Number: P402
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster