Refractory Anemia in Huge Hiatal Hernia: Surgical Management.

Wael N Abdelsalam, MD, Khaled M Katri, MD, Galal M Abouelnagah, MD, Elsaid Elkayal, MD, Tamer N Abdelbaki, MD, MRCS, Msc. University of Alexandria Faculty of Medicine.

BACKGROUND:
The prevalence of hiatal hernias found on upper gastrointestinal endoscopy ranges from 0.8–2.9%. Hiatal Hernia has been notoriously associated with chronic anemia. We herein explore the prevalence and resolution of anemia after surgical treatment of hiatal hernia.

METHODS:
Retrospective study, of patients undergoing laparoscopic hiatal hernia repair between January 2010 and January 2013. Patient with co existing chronic anemia were included. Patient demographics, symptoms, prevalence and resolution of anemia were recorded.

RESULTS:
Forty patients underwent laparoscopic hiatal hernia repair. Mean age was 31±3.4 (range 28-67 years) including 28 females (70%) and 12 males (30%). Nine (22.5%) out of 40 patients had a chronic anemia refractory to medical management. Anemia was symptomatic in 13 patients (32.5%) and was incidentally discovered in 27 patients, during their preoperative work up. Mean Hemoglobin level was 10.1±0.7 mg/dl (range 9-11 mg/dl). Endoscopic examination revealed diffuse gastropathy in all patients and displayed longitudinal ulcers in 3 patients.

All patients underwent laparoscopic Nissen fundoplication. Post operative course was uneventful. Post operative follow up at 6 months revealed anemia resolution in all patients.

CONCLUSIONS:
The prevalence of anemia in association to large hiatal hernia was common. Most of our patients were symptomatic. A relatively high percentage of patients were resistant to medical treatment. Surgical management was effective in curing anemia.

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