Alex Addo, MD, Reilly Scott, Moneim M Ali, MD, Zachary Sanford, MD, Adam S Weltz, MD, Richard Lu, MD, Reza Zahiri, DO, Adrian Park, MD, FACS. Anne Arundel Medical Center
Background: Cameron lesions (CL) are one of the complications of large hiatal hernia (HH) disease, which my lead to chronic blood loss with resultant microcytic anemia. There is support in the literature that repair of HH may lead to resolution of Cameron lesions and restore normal hemoglobin levels. This study aimed to determine the impact of elective HH repair on anemia and the quality of life (QOL) in patients with Cameron lesions.
Method: A retrospective review analyzed all patients with history of CL or anemia (hemoglobin < 12.0 gm/dl in women, < 13.5 gm/dl in men) who underwent HH repair at our institution from January of 2012 to June of 2018. Four validated surveys were used to assess QOL: Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Health-Related QOL (GERD-HRQL), Laryngopharyngeal Reflux Health-Related QOL (LPR-HRQL), and QOL and Swallowing Disorders (SWAL) survey. History of CL, anemia, blood transfusions, intravenous iron infusion, oral iron supplements, lowest preoperative and most recent postoperative hemoglobin were noted.
Results: Sixty-six patients were included in this study. The median age was 68 years (range, 39-91 years) and 81.8% of patients were female. CL were endoscopically identified in 54.5% of patients preoperatively, the rest of the patients experienced anemia of undiagnosed origin but had a high suspicion for CL. Mean follow-up after HH repair was 3.2 months. Mean preoperative hemoglobin was 9.5 (3.7-15.7) gm/dl and 13.1 (8-16.8) gm/dl post-operatively (p<0.01). Forty-eight (72.7%) patients had resolution of anemia during follow-up. All patients stopped supplemental oral iron. Two patients did require blood transfusions and 1 required intravenous iron therapy. The QOL scores significantly improved after surgical intervention: RSI (50.3%), GERD-HRQL (67%), LPR-HRQOL (62.4%) and SWAL (16.9%). Overall complication rate was 6.1%.
Conclusion: Elective hiatal hernia repair in patients with chronic anemia secondary to CL may potentially resolve CL and anemia contributing to significant QOL improvements. Future studies must prospectively assess the resolution of CL with biochemical and endoscopic followup to confirm the preliminary findings of our analysis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95561
Program Number: S086
Presentation Session: Foregut III
Presentation Type: Podium