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Surgical Repair of Large Hiatal Hernias: Insight from a High-Volume Center

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic-assisted hiatal hernia (HH) repair is safe and effective; however, it is unclear whether hernia size affects perioperative outcomes and whether a watch-and-wait strategy is appropriate for patients with asymptomatic large HHs. We aimed to investigate these issues.

Methods

After IRB approval, we queried our prospectively maintained database for patients who underwent primary laparoscopic HH repair at our center between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). According to the intraoperative findings, HHs were divided into four groups: small (S-HH), medium (M-HH), large (L-HH), or giant (G-HH) when the percentage of herniated stomach was 0% (sliding), < 50%, 50–75%, or > 75%, respectively. Perioperative and mid-term outcomes were analyzed.

Results

A total of 170 patients were grouped: S-HH (n = 46), M-HH (n = 69), L-HH (n = 20), and G-HH (n = 35) with mean age of 58.5.6 ± 11.0, 61.9 ± 11.3, 70.7 ± 10.3, and 72.6 ± 9.7 years (p < 0.001), respectively. Compared to M-HH patients, L-HH patients had significantly longer hospital stays (mean 2.8 ± 3.2 vs 1.4 ± 0.91 days; p = 0.001) and more postoperative complications (6/20 [30.0%] vs 3/69 [4.3%]; OR 6.9, 95% CI 5.4–8.4, p < 0.001). At a mean follow-up time of 43.1 ± 25.0 and 43.5 ± 21.6 months for the combined S/M-HH and L/G-HH groups, GERD-Health-Related Quality of Life scores were comparable (S/M-HH: 6.5 ± 10.9 vs L/G-HH: 7.1 ± 11.3; p = 0.63). There was no perioperative mortality.

Conclusions

HHs likely grow with age, reflecting their progressive nature. Laparoscopic L-HH repair was associated with higher morbidity than M-HH repair. Thus, patients with M-HH, even if less symptomatic, should be evaluated by a foregut surgeon. Regardless of HH size, good mid- and long-term quality of life outcomes can be achieved.

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Acknowledgements

The authors thank Kristine Nally for editorial assistance and Marco Marchionni for graphic design.

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Authors and Affiliations

  1. Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, 500 W Thomas Rd, Suite 500, Phoenix, AZ, 85013, USA

    Luca Giulini, Deepika Razia, Andrés R. Latorre-Rodríguez, Mate Csucska & Sumeet K. Mittal

  2. Department of General, Gastrointestinal and Thoracic Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany

    Luca Giulini

  3. Creighton University School of Medicine – Phoenix Regional Campus, Phoenix, AZ, USA

    Deepika Razia, Mark Shacker & Sumeet K. Mittal

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  1. Luca Giulini
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  2. Deepika Razia
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Contributions

Mittal made significant contributions to the conception of the work, revising the paper for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work. Giulini, Razia, Csucska, Latorre-Rodriguez, and Shacker made significant contributions to the acquisition, analysis and interpretation of the data, drafting and revising the paper for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work.

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Correspondence to Sumeet K. Mittal.

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Previous Presentation

This work was accepted as an ePoster Presentation at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2021, Las Vegas, NV, USA.

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Giulini, L., Razia, D., Latorre-Rodríguez, A.R. et al. Surgical Repair of Large Hiatal Hernias: Insight from a High-Volume Center. J Gastrointest Surg 27, 2308–2315 (2023). https://doi.org/10.1007/s11605-023-05829-z

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