Laparoscopic Repair of Giant Paraesophageal Hernia Results in Long-Term Patient Satisfaction and a Durable Repair

Abstract

LRGPEH performed in our minimally invasive center of excellence resulted in a durable repair with a high degree of satisfaction and preservation of GERD-related QoL at a median follow-up of over 6 years.

Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

“…In a number of cohort studies where patients were selected to have a GHH repair it has been reported that: 80% to 92% of preoperative symptoms resolve [2,40]; there is an improved gastro-intestinal quality of life [37,40,41]; there is an objective improvement in pulmonary function [35] and there is an objective improvecy towards a lower mean LOS pressure/tone, reduced LOS length and reduced intra-abdominal length of LOS contributing to the increased likelihood of GORD [22][23][24][25]28,30]. It is important to note that some patients with GHH have normal LOS pressures, which may explain why reflux is not always a major symptom in this group of patients [22,30].…”

“…There are series reporting the use of this technique in 4% to 86% of patients treated for GORD with the higher rates in patients with larger hernias [41,44]. This procedure adds to the technical challenge of repair of the GHH.…”

“…The risk of a symptomatic recurrent HH after GHH repair has been reported to be 5% after ten years of follow-up [36,40,41]. These symptoms can include recurrent reflux, dysphagia, chest pain, nausea and bloating [46].…”

“…These symptoms can include recurrent reflux, dysphagia, chest pain, nausea and bloating [46]. If thorough radiological assessment is performed, a recurrent HH has been defined in 15% to 42% of patients (median 22%) [1,13,36,37,41]. Wang, et al reported a prospective study looking at the clinical significance of asymptomatic recurrences and found that 35.7% of patient had a radiological recurrence [47].…”

“…Radiological recurrence is typically not to the same extent as the originally repaired GHH. Mostly these are small axial asymptomatic, hernias of less than 2 cm in length, of which the clinical importance is likely to be trivial [1,41]. In patients who only have recurrent reflux following a HH repair, medical management provides good symptomatic relief in the majority without ment in cardiac function [42].…”