Durability of giant hiatus hernia repair in 455 patients over 20 years

Abstract

INTRODUCTION The surgical management of symptomatic giant hiatus hernia (GHH) aims to improve quality of life (QoL) and reduce the risk of life threatening complications. Previous reports are predominantly those with small sample sizes and short follow-up periods. The present study sought to assess a large cohort of patients for recurrence and QoL over a longer time period. METHODS This was a follow-up study of a prospectively collected database of 455 consecutive patients. Primary repair of GHH was evaluated by endoscopy/barium meal for recurrence and a standardised symptom questionnaire for QoL. Recurrence was assessed for size, elapsed time, oesophagitis and symptoms. RESULTS Objective and subjective review was achieved in 91.9% and 68.6% of patients. The median age was 69 years (range: 15-93 years) and 64% were female. Laparoscopic repair was completed in 95% (mesh in 6% and Collis gastroplasty in 7%). The 30-day mortality rate was 0.9%. The proportion of patients alive at five and ten years were 90% and 75% respectively. Postoperative QoL scores improved from a mean of 95 to 111 (p<0.01) and were stable over time (112 at 10 years).The overall recurrence rate was 35.6% (149/418) at 42 months; this was 11.5% (48/418) for hernias >2cm and 24.2% (101/418) for <2cm. The rate of new recurrence at 0-1 years was 13.7% (>2cm = 3.4%, <2cm = 10.3%), at 1-5 years it was 30.8% (>2cm = 9.5%, <2cm = 21.3%), at 5-10 years it was 40.1% (>2cm = 13.8%, <2cm = 26.3%) and at over 10 years it was 50.0% (>2cm = 25.0%, <2cm = 25.0%). Recurrence was associated with oesophagitis but not decreased QoL. Revision surgery was required in 4.8% of cases (14.8% with recurrence). There were no interval major GHH complications. CONCLUSIONS Surgery has provided sustained QoL improvements irrespective of recurrence. Recurrence occurred progressively over ten years and may predispose to oesophagitis.

Laparoscopic repair of large hiatal hernias: clinical outcomes of 10 years

“…However, patients with radiological evidence of failure or recurrent symptoms had a small but significant reduction in the QoL scores compared to patients without recurrence. The impact of recurrent hiatus hernia on symptoms after repair in our study was different to other large series where QoL appeared not to be affected following recurrence . In our patients, oesophagitis was common after recurrence, and Barrett's oesophagus was found in two patients.…”

“…The impact of recurrent hiatus hernia on symptoms after repair in our study was different to other large series where QoL appeared not to be affected following recurrence. 9,12,14 In our patients, oesophagitis was common after recurrence, and Barrett's oesophagus was found in two patients. Aly et al also identified a significant rate of Barrett's epithelium of 13% on preoperative endoscopy.…”

“…However, large hiatus hernias are mainly identified in the elderly, and as age increased, patients became more difficult to locate and contact, as well as more unfit and less willing to undertake tests (especially if not symptomatic). Many other long‐term follow‐up studies have faced similar difficulties with obtaining adequate information and follow‐up following surgical procedures . Dallemagne et al .…”

“…Many other longterm follow-up studies have faced similar difficulties with obtaining adequate information and follow-up following surgical procedures. 9,12,13 Dallemagne et al reported a mean follow-up of 118 months (range: 17-177 months) in a series of 85 patients, but information was only available for 64 (75%) of 85 patients. 9 In Targarona et al's study, 55 of the 77 patients were available for interview (71%), and the mean follow-up was 108 months (range: 48-160 months).…”

Differentiated approach to the choice of plastic surgery for hiatal hernia

“…Как известно, чем больше размер ПОД, соответственно, выше риск развития рецидива после оперативных вмешательств по поводу ГПОД, так как создается избыточное натяжение сшиваемых ножек диафрагмы с возможностью последующего прорезывания швов [2]. Число рецидивов может достигать 66%, особенно при больших и гигантских ГПОД [3]. Это объясняется тем, что до сих пор не существует единого алгоритма при выполнении пластики ПОД, как и остается нерешенным вопрос об использовании сетчатых имплантатов.…”