Curtis E Bower, MD, FACS, Troy Miller, Daniel L Davenport, PhD, John S Roth, MD, FACS
University of Kentucky, Department of Surgery
Intro: Paraesophageal hernia repair with mesh result in reduced short term recurrence rates although long term recurrences remain similar to repairs without mesh. The impact of mesh placed at the esophageal hiatus upon post-operative outcomes and patient satisfaction is not well understood. This study compares patient outcomes following PEH repair with and without mesh.
Methods: After IRB approval, a telephone questionnaire survey was conducted for all patients that underwent laparoscopic paraesophageal repair between 2004 and 2011 at a single institution. Multiple attempts were made to call each patient. Demographics and operative details were obtained from the health records. Statistical analysis of results was performed using T-Test, Chi-Square and Mann-Whitney tests where appropriate.
Results: One hundred fifty-nine patients underwent PEH repair of which 82 (51.6%) completed the survey. Forty-five (54.9%) patients underwent paraesophageal hernia repair with mesh (PEH-M) and 37(45.1%) without mesh (PEH). The mean surgical follow-up of all respondents was 2.1 years. PEH-M patients were older (63.6 vs. 52.6, p<0.001), but BMI was similar (29.2 vs. 31.4, p=0.131) in PEH-M and PEH respectively. Survey results demonstrate no significant difference in difficulty with swallowing liquids or solids (p= 0.190 and 0.944, respectively). PEH-M demonstrated reduced pain with swallowing, mean score 5, IQR 5-5 compared to PEH mean 5, IQR 2.5-5 (p=0.023). There was no difference in the severity of swallowing difficulty (p=0.272) or the frequency of swallowing difficulty (p=0.297) between groups. Recurrent hernias were noted in 8 (9.8%) patients of whom 6 were among patients who had undergone recurrent paraesophageal hernia repairs. Recurrent hernias were seen in 60% of recurrent repairs and 2.4% of primary paraesophageal hernia repairs. Amongst non-recurrent repairs, recurrences occurred similarly between PEH-M and PEH (4.4% vs. 0%).
Conclusions: Patients undergoing a paraesophageal hernia repair can have mesh placed at the hiatus safely and with no significant difference in pain or dysphagia. The question of how to best prevent hernia recurrence remains elusive. Further prospective studies are needed to identify the optimal techniques for paraesophageal hernia repair.
Session: Poster Presentation
Program Number: P243
