Outcomes After Repair of the Intra-thoracic Stomach: Objective Follow-up Up to 5 Years

Laparoscopic surgery is a viable treatment option for intra-thoracic stomach (ITS); however doubts have been raised regarding its efficacy. Routine use of mesh has been advocated. The aim of this study is to look at long term objective and symptomatic outcomes after repair of ITS with selective use of mesh and fundoplication.

A retrospective review of prospectively collected data was performed to identify patients who underwent surgical treatment of ITS from Jan 2004 to Sep 2008 at Creighton University Medical Center. ITS was defined as herniation of greater than 75% of the stomach into the chest on a barium swallow. A standardized foregut symptom questionnaire was administered along with contrast study at 1, 3 and 5 yrs post-surgery.

Sixty-nine patients with a mean age of 71.2 years (44-88) had surgical treatment of ITS. There were 46 (67%) females. There were 7 trans-thoracic and 62 trans-abdominal repairs (59 laparoscopic and 3 open conversions). There was one intra-op death due to bleeding. Anti-reflux surgery was performed in 38 patients (21 Nissen, 13 Toupet, 1 Dor and 3 Roux-en-Y gastric bypass). Of these 10 patients also had Collis gastroplasty for a short esophagus. In the remaining 30 patients excision of the hernia sac and crural repair was done. Mesh was used in 6 (8.7%) patients for crus reinforcement. Objective follow-up was available for 89%, 76% and 75% at 1, 3 and 5 years respectively. There were 7% (4/59) radiological failures (one patient required emergent re-operation) within the first year. No additional recurrences were noted at 3 and 5 years. There was no significant difference in mean symptom and satisfaction scores or use of PPI between the patients with and without fundoplication. Mean satisfaction scores were 9.4, 9.0 and 9.3 at 1, 3 and 5 years respectively

Laparoscopic repair of ITS is feasible, safe and durable with selective use of mesh and fundoplication and results in a high degree of patient satisfaction. Low recurrence rates at 1 year were achieved with no incremental failures up to 5 years. Longer follow-up with larger number of patients is needed to confirm these findings.

Session: Podium Presentation

Program Number: S081

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