Symptomatic Recurrence After Paraesophageal Hernia Repair – Does Surgical Approach Affect Outcome?

A Porte, MD, FRCSC, J Mamazza, MD, FRCSC, F Haggar, PhD, I Raiche, MD, FRCSC, Jd Yelle, MD, FRCSC, J Masters, MD, FRCSC, Jc Gauthier, MD, FRCSC

University of Ottawa, Ottawa Hospital Research Institute

Introduction

The objective of this study is to determine whether the type of surgical approach (laparoscopy, laparatomy, thoracotomy) for paraesophageal hernia (PEH) repair affects post-surgical outcomes.

Methods

Prospectively collected patient demographics, pre-operative data, surgical details and complications were obtained for patients treated at the Ottawa Hospital between January 2004 and January 2012. We used the Kruskal-Wallis 1-way ANOVA to compare median length of stay (LOS), age, BMI, and operative times across the three surgical approaches. Chi-squared or Fisher’s exact tests were used to compare type of surgical booking (elective or emergency), sex, ASA score, type of hernia, previous abdominal surgery, intra-operative complications, post-operative complications and symptomatic recurrence between the treatment groups.

Results

A total of 299 patients underwent laparoscopy (n=208), laparotomy (n=56) or thoracotomy (n=35) for paraesophageal hernia repair. The following baseline characteristic and preoperative details did not differ between the groups: sex, respiratory co-morbidities (COPD, Asthma), smoking status or DeMeester scores (p>0.05). The mean age (p<0.0001), BMI (p <0.001), and type of admission (emergency/elective) (p<0.001) differed significantly.

We found no difference in intra-operative complications. Post-operative complications measured were wound infection, leak, abscess, hemorrhage, and mortality. Of these, only wound infection was found to be statistically significant in favor of laparoscopy (laparoscopy 3%, laparotomy 13%, thoracotomy 11%; p<0.007).

The length of stay was shorter for laparoscopy (5 days) compared with laparotomy (18 days), and thoracotomy (15 days) (p <0.001). Patients undergoing laparotomy were slower to progress to a regular diet (mean=10 days) compared with the laparoscopic (5 days) and thoracotomy (6 days) groups (0.0001)

There was no difference in symptomatic recurrence across groups (p>0.05).

Conclusions

Minimally invasive paraesophageal repair significantly decreased post-operative wound infections. As well, these patients were discharged from hospital significantly earlier. Given these results, and the fact that symptom control was equivalent between groups, a minimally invasive approach should be considered for all patients requiring paraesophageal hernia repair.

Session: Poster Presentation

Program Number: P255