Health-related quality of life after laparoscopic repair of giant paraesophageal hernia: how does recurrence in CT scan compare to clinical success?

Abstract

Background: Computed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up. We performed a cross-sectional observational study to assess mid-term outcomes of elective laparoscopic GPEH repair. The primary objective of the study was to evaluate the radiological hernia recurrence rate by CT and to determine its association with current symptoms and quality of life. Methods: All non-emergent laparoscopic GPEH repairs between 2010 to 2015 were identified from hospital medical records. Each patient was offered non-contrast CT and sent questionnaires for disease-specific symptoms and health-related quality of life. Results: The inclusion criteria were met by 165 patients (74% female, mean age 67 years). Total recurrence rate was 29.3%. Major recurrent hernia (> 5 cm) was revealed by CT in 4 patients (4.3%). Radiological findings did not correlate with symptom-related quality of life. Perioperative mortality occurred in 1 patient (0.6%). Complications were reported in 27 patients (16.4%). Conclusions: Successful laparoscopic repair of GPEH requires both expertise and experience. It appears to lead to effective symptom relief with high patient satisfaction. However, small radiological recurrences are common but do not affect postoperative symptom-related patient wellbeing.

Research protocol for the Paraesophageal hernia symptom tool, a prospective multi-center cohort study to identify the need and threshold for surgery and assess the symptom response to surgery

“… 3–5 The prevalence of upper gastrointestinal symptoms in paraesophageal hernias provides the rationale for using health-related quality of life (HRQoL) questionnaires focusing on gastro-esophageal reflux disease (GORD) to assess patients before and after surgery. 6–8 As the questionnaires are focused on GORD symptoms alone, they do not take into consideration the other symptoms that are associated with paraesophageal hernias. The symptoms that are not included in the current HRQoL tools are sometimes the very reason patients seek surgical intervention.…”

“…The symptoms that are not included in the current HRQoL tools are sometimes the very reason patients seek surgical intervention. 6–8 …”