Laparoscopic fundoplication for para-oesophageal hernia repair improves respiratory function in patients with dyspnoea: a prospective cohort study

Abstract

Background Dyspnoea in patients with a para-oesophageal hernia (PEH) occurs in 7% to 32% of cases and is very disabling, especially in elderly patients, and its origin is not well defined. The present study aims to assess the impact of PEH repair on dyspnoea and respiratory function. Methods From January 2019 to May 2021, all consecutive patients scheduled for PEH repair presenting with a modified Medical Research Council (mMRC) score ≥ 2 for dyspnoea were included. Before and 2 months after surgery, dyspnoea was assessed by both the dyspnoea visual analogue scale (DVAS) and the mMRC scale, as well as pulmonary function tests (PFTs) by plethysmography. Results All 43 patients that were included had pre- and postoperative dyspnoea assessments and PFTs. Median age was 70 years (range 63–73.5 years), 37 (86%) participants were women, median percentage of the intrathoracic stomach was 59.9% (range 44.2–83.0%), and median length of hospital stay was 3 days (range 3–4 days). After surgery, the DVAS decreased statistically significant (5.6 [4.7–6.7] vs. 3.0 [2.3–4.4], p < 0.001), and 37 (86%) patients had a clinically significant decrease in mMRC score. Absolute forced expiratory volume in one second (FEV1), total lung capacity, and forced vital capacity also statistically significantly increased after surgery by an average of 11.2% (SD 17.9), 5.0% (SD 13.9), and 10.7% (SD 14.6), respectively. Furthermore, from the subgroup analysis, it was identified that patients with a lower preoperative FEV1 were more likely to have improvement in it after surgery. No correlation was found between improvement in dyspnoea and FEV1. There was no correlation between the percentage of intrathoracic stomach and dyspnoea or improvement in PFT parameters. Conclusion PEH repair improves dyspnoea and FEV1 in a statistically significant manner in a population of patients presenting with dyspnoea. Patients with a low preoperative FEV1 are more likely to have improvement in it after surgery.

Lap. Nissen fundoplication leads to better respiratory symptom control than Toupet in the long term of 20 years

“…f: female; m: male; LTF: laparoscopic Toupet fundoplication; LNF: laparoscopic Nissen fundoplication. Erosive esophagitis is defined according to the Savary–Miller staging system [ 9 ], Barrett’s is defined as intestinal columnar cell metaplasia with the presence of goblet cells on histology, hiatal hernia is classified in 4 types [ 36 ]: I sliding hiatal hernia and II–IV paraesophageal hernia, whereas in type II the stomach migrates into the chest and ‘‘rolls’’ over the esophagus with the gastroesophageal junction still laying down into the abdomen; type III occurs when the stomach migrates into the chest and ‘‘rolls’’ over the esophagus with the concomitant migration of the gastroesophageal junction into the chest; type IV occurs when, together with the stomach, there is herniation of other intra-abdominal contents through the hiatus [ 37 ] patient's characteristics median (5%-95%) Age (years) 49 (28–71) Duration of symptoms (years) 10 (1,5–30) Sex n f 55 (LTF: 33; 36, 3%) (LNF 22; 34, 4%) m 100 Erosive Esophagitis pre-OP ( n ) % post-OP ( n ) % undef. 51 32, 9 36 23, 2 0 7 4, 5 117 75, 5 I 11 7, 1...…”