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The Impact of Scoliosis Among Patients with Giant Paraesophageal Hernia

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Kyphoscoliosis is seen in approximately 1.4–15% of the octogenarian population of the US. We hypothesized that patients with kyphoscoliosis are affected with a reduced intra-abdominal volume and progressive laxity of the diaphragmatic hiatal sling musculature leading to an increased risk of hiatal hernia formation and progression over time.

Methods

We retrospectively reviewed the clinical history and roentgenographic data of 320 paraesophageal hernia patients from 2003 to 2007. The prevalence of kyphoscoliosis among this patient cohort and the outcomes of surgical management were compared to paraesophageal hernia patients without kyphoscoliosis.

Results

Ninety-three of the 320 patients (29.1%) were found to have significant K/S (mean age 74; 83% female). Laparoscopic repair of paraesophageal hernia with fundoplication was performed in 91% of these patients. There was one death (1.1%; aspiration pneumonia) and 17.2% major postoperative morbidity. Mean length of hospital stay was 8 days (median = 4; range 2–71). Prolonged stays were related mainly to marginal pulmonary status. Kyphoscoliosis was associated with increased peri-operative pulmonary morbidity (16.1%) compared to patients without kyphoscoliosis (7.0%, p = 0.02).

Conclusion

Kyphoscoliosis may contribute to the development and progression of paraesophageal hernias. Surgeons approaching paraesophageal hernia repair should be aware of the increased pulmonary morbidity and the postoperative care required in managing these patients.

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Acknowledgements

The authors would like to acknowledge the assistance of Carl R. Fuhrman M.D. (UPMC Department of Radiology) in CXR analysis. The authors also wish to acknowledge the important contributions of Kathy Lovas, Theresa Krupka, Diane Sabilla, and Darla Justus in database organization and management.

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Authors and Affiliations

  1. Division of Thoracic and Foregut Surgery; Heart, Lung and Esophageal Surgery Institute, UPMC Health System, Pittsburgh, PA, USA

    Matthew J. Schuchert, Prasad S. Adusumilli, Chris C. Cook, Christos Colovos, Arman Kilic, Katie S. Nason, Joshua P. Landreneau, Thomas Zikos, Robert Jack, James D. Luketich & Rodney J. Landreneau

  2. Heart, Lung and Esophageal Surgery Institute, Shadyside Medical Building—Suite 715, 5200 Centre Avenue, Pittsburgh, PA, 15232, USA

    Matthew J. Schuchert

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  1. Matthew J. Schuchert
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  2. Prasad S. Adusumilli
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Correspondence to Matthew J. Schuchert.

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Meeting Presentation

The Society for Surgery of the Alimentary Tract 49th Annual Meeting, San Diego, CA; May 17–21, 2008 [Poster of Distinction].

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Schuchert, M.J., Adusumilli, P.S., Cook, C.C. et al. The Impact of Scoliosis Among Patients with Giant Paraesophageal Hernia. J Gastrointest Surg 15, 23–28 (2011). https://doi.org/10.1007/s11605-010-1307-7

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  • DOI: https://doi.org/10.1007/s11605-010-1307-7

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