Long-term Quality of Life and Risk Factors for Recurrence After Laparoscopic Repair of Paraesophageal Hernia

Lidor, Anne O.; Steele, Kimberley E.; Stem, Miloslawa; Fleming, Richard M; Schweitzer, Michael; Marohn, Michael R.

doi:10.1001/jamasurg.2015.25

Cited by 83 publications

(47 citation statements)

References 34 publications

(31 reference statements)

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“…With these data, it is possible to think that an asymptomatic small gastric reherniation is frequently observed after operation, without this being considered a true recurrence. This idea is also shared by Lidor et al 21 The lengths of gastric folds observed above the esophagogastric junction should be separated into 3 categories: smaller than 2 cm, 3 to 5 cm, and larger than 5 cm. The following categorization of recurrence is proposed, assigning a score to the presence of symptoms, endoscopic findings and radiologic findings: no recurrence, 0 points; asymptomatic recurrence, 1 point (relative recurrence); and symptomatic recurrence, 2 to 3 points (''true'' or absolute recurrence).…”

Section: Discussionmentioning

confidence: 77%

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Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Braghetto

Lanzarini

Musleh

et al. 2018

International Surgery

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Background: High rates of recurrence after laparoscopic hiatal hernia repair have been published. Most of these recurrences are asymptomatic and only diagnosed by endoscopic or radiologic studies. The definition of hiatal hernia recurrence is still under discussion.Objective: This study aimed to define a true hiatal hernia recurrence using a score and classification criteria considering the presence of symptoms and size of the recurrence.Patients and Methods: A total of 153 patients with giant hiatal hernia larger than 10 cm in diameter underwent an operation using a laparoscopic approach. Of these patients, 129 had a complete follow-up (3-5 years) after surgery, and they were the only ones included in this study. The IT system of our hospital was our database for data registration. A score and classification were designed for definition of a ''true'' hiatal hernia recurrence, based on postoperative symptoms and the presence or not of a hiatal hernia in both radiologic and endoscopic evaluations.Results: Hiatal hernia recurrence based on endoscopic and/or radiologic hiatal hernia was found in 55 patients (42.6%), and only 28 of them (50.9%) had recurrent symptoms. Applying the score and proposed classification, no recurrence was considered in 18 patients (13.9%). Symptomatic and true recurrence were considered in 22.9% of patients (29 patients). Reoperation was needed for 7 patients (5.4%) because of symptomatic and radiologic recurrence.

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Section: Discussionmentioning

confidence: 77%

“…A total of 29 patients (23%) had recurrence, and only 9 (31%) were symptomatic, and the quality of life was significantly better after surgery. Lidor et al 21 showed there was a significant improvement in symptoms score in all patients, even in patients with recurrent hiatal hernia. Also, the quality-of-life index improved similarly.…”

Section: Discussionmentioning

confidence: 92%

Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Braghetto

Lanzarini

Musleh

et al. 2018

International Surgery

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“…This is similar with previously published recurrence rates using this common definition. Lidor et al in their series of Type III hernias noted a one-year recurrence rate of 27% with this definition (13). In the largest review of laparoscopic GPEH repair, Luketich et al examined their decade of experience, and noted a recurrence rate of 15.7% at a median of 22 months after repair.…”

Section: Discussionmentioning

confidence: 99%

“…However, few studies have examined the results of GPEH repair in a prospective manner with routine imaging post-operatively. The prospective data with routine post-operative barium swallow studies that do exist is hindered by small study populations or low patient participation at long-term follow-up (12, 13). Therefore, the objective of this trial was to prospectively evaluate all patients undergoing elective repair of GPEH, and to evaluate these patients for recurrence and measures of quality of life.…”

Section: Introductionmentioning

confidence: 99%

Prospective study of giant paraesophageal hernia repair with 1-year follow-up

Stringham

Phillips

McMurry

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Objective Evaluating giant paraesophageal hernia (GPEH) repair requires long-term follow-up. GPEH repair can have associated high recurrence rates, yet this incidence depends on how recurrence is defined. Our objective was to prospectively evaluate patients undergoing GPEH repair with one-year follow-up. Methods Patients undergoing elective GPEH repair between 2011 and 2014 were prospectively enrolled. Postoperatively, patients were evaluated at one-month and one-year. Radiographic recurrence was evaluated by barium swallow and defined as a gastroesophageal junction located above the hiatus. Quality of life was evaluated pre- and post-operatively using a validated questionnaire. Results One-hundred six patients were enrolled. The majority of GPEH repairs were performed laparoscopically (80.2%) and 7.5% were redo repairs. At one-year follow-up, 63.4% of patients were symptom free and radiographic recurrence was 32.7%. Recurrence rate was 18.8% with standard definition (> 2cm of stomach above the diaphragm). Quality of life scores at one year were significantly better following operative repair, even in patients with radiographic recurrence (7.0 vs. 22.5 all patients, 13.0 vs 22.5 with recurrence (P<0.001). Patients with small radiographic recurrences have similar satisfaction and symptom severity to patients with > 2 cm recurrences. Conclusions GPEH repair can be performed with low operative mortality and morbidity. The rate of recurrence at one year depends on the definition used. Patient satisfaction and symptom severity are similar between patients with radiographic and >2cm hernia recurrences. Longer follow-up and critical assessment of our results are needed to understand the true impact of this procedure and better inform perioperative decision making.

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“…However most patients remain asymptomatic, thus the relevance of this method may be questioned. 82,83 Median time for radiologic recurrence is 40 months. 84 It might be beneficial to only report symptomatic recurrence, which is more relevant in the treatment of patients.…”

Section: Predictors For Outcomementioning

confidence: 99%

Outcome after laparoscopic antireflux surgery and hiatal hernia repair

Castelijns¹

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Long-term Quality of Life and Risk Factors for Recurrence After Laparoscopic Repair of Paraesophageal Hernia

Abstract: Overall, laparoscopic repair of PEH with biological mesh results in excellent long-term QOL. The cause of recurrence is likely multifactorial and individualized to each patient. Further evaluation of novel techniques and unidentified patient factors is needed.

Cited by 83 publications

References 34 publications

Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Prospective study of giant paraesophageal hernia repair with 1-year follow-up

Outcome after laparoscopic antireflux surgery and hiatal hernia repair

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