Skip to main content
SpringerLink
Log in

Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Initial experience with the laparoscopic repair of paraesophageal and type III mixed hiatal hernias showed that it is safe and feasible, with excellent immediate and short-term results. However, after a longer follow-up, a recurrence rate of ≤40% has been demonstrated. Data related to the outcome of paraesophageal hernia repair and the recurrence rate are still lacking. Quality-of-life scores may offer a better means of assessing the impact of surgical treatment on the overall health status of patients. Therefore, we performed prospective evaluation of anatomic and/or symptomatic recurrences after paraesophageal or large hiatal hernia repair. In addition, we investigated the correlation between recurrence and the patient’s quality of life.

Methods

All patients after who had undergone repair of paraesophageal of mixed hiatal hernia were identified prospectively from a database consisting of all patients who had had laparoscopic operations for gastroesophageal pathology at our hospital between February 1998 and December 2002. The preoperative symptoms were taken from patients’ clinical files. In March 2003, all patients with ≥6 months of follow-up had a barium swallow and were examined for radiological and clinical signs of recurrence. Thereafter, the patients’ quality of life after surgery was evaluated using three standard questionnaires (Short Form 36 [SF-36], Glasgow Dyspepsia Severity Score [GDSS], and Gastrointestinal Quality of Life Index [GIQLI].

Result

During the study period, 46 patients had been operated on. The mean age was 63 years (range, 28–93). Thirty seven of them had a follow-up of ≥6 months. Eight patients (21%) had postoperative gastrointestinal symptoms. Barium swallow was performed in 30 patients (81%) and showed a recurrence in six of them (20%). According to SF-36 and GDSS, the patients’ postoperative quality of life reached normal values and did not differ significantly from the standard values for the Spanish population of similar age and with similar comorbidities. Successfully operated patients reached a GIQLI value comparable to the standard population. However, symptomatic patients had significantly lower GIQLI scores than the asymptomatic or the Rx-recurrent group.

Conclusion

The laparoscopic treatment of large paraesophageal and mixed hiatal hernias is not only feasible and safe but also offers a good quality of life on a midterm basis. However, the anatomic and functional recurrence rate is high. The next step is to identify the subset of patients who are at risk of failure and to establish technical alternatives that would ensure the durability of the repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. J Alonso E Regidor G Barrio L Prieto C Rodriguez L Fuente (1998) ArticleTitleValores poblacionales de referencia de la versión española del cuestionario de salud SF-36 Med Clin (Barc) 111 410–416 Occurrence Handle1:STN:280:DyaK1M%2FltF2kug%3D%3D

    CAS  Google Scholar 

  2. J Camilleri-Brennan RJC Steele (1999) ArticleTitleMeasurement of quality of life in surgery J R Coll Surg Edinb 44 252–259 Occurrence Handle1:STN:280:DyaK1Mzot1Ghsw%3D%3D Occurrence Handle10453149

    CAS  PubMed  Google Scholar 

  3. JK Champion D Rock (2003) ArticleTitleLaparoscopic mesh cruroplasty for large paraesophageal hernias Surg Endosc 17 551–553 Occurrence Handle10.1007/s00464-002-8817-7 Occurrence Handle1:STN:280:DC%2BD3s7nvFGqsA%3D%3D Occurrence Handle12582773

    Article  CAS  PubMed  Google Scholar 

  4. PS Dahlberg C Deschamps DL Miller MS Allen FC Nichols PC Pairolero (2001) ArticleTitleLaparoscopic repair of large paraesophageal hiatal hernia Ann Thorac Surg 72 1125–1129 Occurrence Handle10.1016/S0003-4975(01)02972-1 Occurrence Handle1:STN:280:DC%2BD3MrlslSmsA%3D%3D Occurrence Handle11603423

    Article  CAS  PubMed  Google Scholar 

  5. S Diaz M Brunt ME Klingensmith PM Frisella NJ Soper (2003) ArticleTitleLaparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 11 patients J Gastroint Surg 7 59–67 Occurrence Handle10.1016/S1091-255X(02)00151-8

    Article  Google Scholar 

  6. MB Edye J Canin-Endres F Gattorno BA Salky (1998) ArticleTitleDurability of laparoscopic repair of paraesophageal hernia Ann Surg 228 528–535 Occurrence Handle10.1097/00000658-199810000-00009 Occurrence Handle1:STN:280:DyaK1M%2FgsFSjsA%3D%3D Occurrence Handle9790342

    Article  CAS  PubMed  Google Scholar 

  7. GM Eisen GR Locke D Provenzale (1999) ArticleTitleHealth-related quality of life: a primer for gastroeneterologists Am J Gastroenterol 94 2017–2021 Occurrence Handle10.1016/S0002-9270(99)00328-7 Occurrence Handle1:STN:280:DyaK1Mznt1Kqtg%3D%3D Occurrence Handle10445522

    Article  CAS  PubMed  Google Scholar 

  8. F Ellis SuffixJr RE Crozier JA Shea (1986) ArticleTitleParaesophageal hiatus hernia Arch Surg 121 416–420 Occurrence Handle3954587

    PubMed  Google Scholar 

  9. E Eyspach JL Williams S Wood-Dauphinee BM Ure E Neugebauer H Troidl (1995) ArticleTitleGastrointestinal quality of life index development; validation and application of a new instrument Br J Surg 82 216–222 Occurrence Handle7749697

    PubMed  Google Scholar 

  10. HC Fernanado PR Schauer M Rosenblat A Wald P Buenaventura S Ikramundin JD Luketich (2002) ArticleTitleQuality of life after antireflux surgery compared with nonoperative management for severe gastroesophageal reflux disease J Am Coll Surg 194 23–27 Occurrence Handle10.1016/S1072-7515(01)01110-3 Occurrence Handle11800337

    Article  PubMed  Google Scholar 

  11. CT Frantzides AK Madan MA Carlson GP Stavropoulos (2002) ArticleTitleA prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia Arch Surg 137 649–652 Occurrence Handle10.1001/archsurg.137.6.649 Occurrence Handle12049534

    Article  PubMed  Google Scholar 

  12. WA Gantert MG Patti M Arcerito C Feo L Stewart M DePinto et al. (1998) ArticleTitleLaparoscopic repair of paraesophageal hiatal hernias J Am Coll Surg 186 428–433 Occurrence Handle10.1016/S1072-7515(98)00061-1 Occurrence Handle1:STN:280:DyaK1c3gsVGiug%3D%3D Occurrence Handle9544957

    Article  CAS  PubMed  Google Scholar 

  13. D Greenworld S Shumway P Albear L Gottlieb (1994) ArticleTitleMechanical comparison of 10 suture materials before and after in vivo incubation J Surg Res 56 372–377 Occurrence Handle10.1006/jsre.1994.1058 Occurrence Handle8152233

    Article  PubMed  Google Scholar 

  14. M Hashemi JH Peters TR DeMeester JE Huprich M Quek JA Hagen PF Crookes (2000) ArticleTitleLaparoscopic repair of large type III hiatal hernia: objective follow up reveals high recurrence rate J Am Coll Surg 190 553–561 Occurrence Handle10.1016/S1072-7515(00)00260-X Occurrence Handle1:STN:280:DC%2BD3c3lvV2lsg%3D%3D Occurrence Handle10801022

    Article  CAS  PubMed  Google Scholar 

  15. H Hawasli S Zonca (1998) ArticleTitleLaparoscopic repair of paraesophageal hiatal hernia Am Surg 64 703–710 Occurrence Handle1:STN:280:DyaK1czmtFelsA%3D%3D Occurrence Handle9697897

    CAS  PubMed  Google Scholar 

  16. LD Hill (1973) ArticleTitleIncarcerated paraesophageal hernia; a surgical emergency Am J Surg 126 286–289 Occurrence Handle1:STN:280:CSyB38npslI%3D Occurrence Handle4721551

    CAS  PubMed  Google Scholar 

  17. S Horgan TR Eubanks G Jacobsen P Omelanczuk CA Pellegrini (1999) ArticleTitleRepair of paraesophageal hernias Am J Surg 177 354–358 Occurrence Handle10.1016/S0002-9610(99)00061-6 Occurrence Handle1:STN:280:DyaK1M3ptF2qsg%3D%3D Occurrence Handle10365868

    Article  CAS  PubMed  Google Scholar 

  18. C Jenkinson H McGee (1998) Generic single-index measures of health status C Jenkinson H McGee (Eds) Health status measurement: a brief but clinical introduction Radcliffe Medical Press Oxford (United Kingdom) .

    Google Scholar 

  19. BA Jobe RW Aye CW Deveney JS Domreis LD Hill (2002) ArticleTitleLaparoscopic management of giant type III hiatal hernia and short esophagus: objective follow up at three years J Gastrointest Surg 6 181–188 Occurrence Handle10.1016/S1091-255X(01)00067-1 Occurrence Handle11992803

    Article  PubMed  Google Scholar 

  20. RM Kaplan (1998) Profile versus utility based measures of out-come for clinical trials RD Hays PM Fayers (Eds) Quality of life assessment in clinical trials Oxford University Press Oxford (United Kingdom)

    Google Scholar 

  21. A Keidar A Szold (2003) ArticleTitleLaparoscopic repair of paraesophageal hernia with selective use of mesh Surg Laparosc Endosc 13 149–154 Occurrence Handle10.1097/00129689-200306000-00002

    Article  Google Scholar 

  22. L Khaitan H Houston K Sharp M Holzman W Richards (2002) ArticleTitleLaparoscopic paraesophageal hernia repair has an acceptable recurrence rate Am Surg 68 546–551 Occurrence Handle12079137

    PubMed  Google Scholar 

  23. PC Leeder G Smith TCB Dehn (2003) ArticleTitleLaparoscopic management of large paraesophageal hiatal hernia Surg Endosc . .

    Google Scholar 

  24. SG Mattar SP Bowers KD Galloway CD Hunter CD Smith (2002) ArticleTitleLong-term outcome of laparoscopic repair of paraesophageal hernia Surg Endosc 16 745–749 Occurrence Handle10.1007/s00464-001-8194-7 Occurrence Handle1:STN:280:DC%2BD383lvVajuw%3D%3D Occurrence Handle11997814

    Article  CAS  PubMed  Google Scholar 

  25. C Mobius HJ Stein M Feith H Feussner JR Siewert (2001) ArticleTitleQuality of life before and after laparoscopic Nissen fundoplication Surg Endosc . .

    Google Scholar 

  26. J Mones A Adan JS Lopez M Artes (2001) ArticleTitleValidation of the Spanish version of the Glasgow Dyspepsia Severity Score Rev Esp Enf Dig 93 170–175

    Google Scholar 

  27. BK Oelschlager CA Pellegrini (2001) ArticleTitleParaesophageal hernias: open, laparoscopic, or thoracic repair Chest Surg Clini of North Am 11 589–603 Occurrence Handle1:STN:280:DC%2BD38%2FmtFKmtA%3D%3D

    CAS  Google Scholar 

  28. BK Oelschlager M Barreca L Chang CA Pellegrini (2003) ArticleTitleThe use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique Am J Surg 186 4–8 Occurrence Handle10.1016/S0002-9610(03)00114-4 Occurrence Handle12842738

    Article  PubMed  Google Scholar 

  29. DL Peet EC Klinkerberg-Knol A Alonso C Sietses QAJ Eijsbouts MA Cuesta (2000) ArticleTitleLaparoscopic treatment of large paraesophageal hernias Surg Endosc 14 1015–1018 Occurrence Handle10.1007/s004640000199 Occurrence Handle11116408

    Article  PubMed  Google Scholar 

  30. G Perdikis RA Hinder CJ Filipi T Walenz PJ McBride SL Smith et al. (1997) ArticleTitleLaparoscopic paraesophageal hernia repair Arch Surg 132 586–590 Occurrence Handle1:STN:280:ByiA2c7lt1Y%3D Occurrence Handle9197849

    CAS  PubMed  Google Scholar 

  31. AF Pierre JD Luketich HC Fernando NA Christie PO Buenaventura VR Litle PR Schauer (2002) ArticleTitleResults of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients Ann Thorac Surg 74 1909–1916 Occurrence Handle10.1016/S0003-4975(02)04088-2 Occurrence Handle12643372

    Article  PubMed  Google Scholar 

  32. J Ponsky M Rosen A Fanning J Malm (2003) ArticleTitleAnterior gastropexy may reduce the recurrence after laparoscopic paraesophageal hernia repair Surg Endosc 17 1036–1041 Occurrence Handle10.1007/s00464-002-8765-2

    Article  Google Scholar 

  33. DB Skinner RH Belsey (1967) ArticleTitleSurgical management of esophageal reflux and hiatus: long-term results with 1,030 patients J thorac Cardiovasc Surg 53 33–54 Occurrence Handle1:STN:280:CCiD2MjotlQ%3D Occurrence Handle5333620

    CAS  PubMed  Google Scholar 

  34. N Stylopoulos GS Gazelle DW Rattner (2002) ArticleTitleParaesophageal hernias: operation or observation? Ann Surg 236 492–451 Occurrence Handle10.1097/00000658-200210000-00012 Occurrence Handle12368678

    Article  PubMed  Google Scholar 

  35. LL Swanstrom BA Jobe LR Kinzie KD Horvath (1999) ArticleTitleEsophageal motility and outcome following laparaoscopic paraesophageal hernia repair and fundoplication Am J Surg 177 359–363 Occurrence Handle10.1016/S0002-9610(99)00062-8 Occurrence Handle1:STN:280:DyaK1M3ptF2qsw%3D%3D Occurrence Handle10365869

    Article  CAS  PubMed  Google Scholar 

  36. EM Targarona G Bendahan C Balague J Garriga M Trias (2004) ArticleTitleA mesh in the hiatus: a controversial issue Arch Surg . .

    Google Scholar 

  37. MA Testa DC Simonson (1996) ArticleTitleAssessment of quality of life outcomes N Engl J Med 334 835–840 Occurrence Handle10.1056/NEJM199603283341306 Occurrence Handle1:STN:280:BymC2snislw%3D Occurrence Handle8596551

    Article  CAS  PubMed  Google Scholar 

  38. TL Trus T Bax WS Richardson GD Branum SJ Mauren LL Swanstrom JC Hunter (1997) ArticleTitleComplications of laparoscopic paraesophageal hernia repair J Gastrointest Surg 1 221–228 Occurrence Handle10.1016/S1091-255X(97)80113-8 Occurrence Handle9834351

    Article  PubMed  Google Scholar 

  39. V Velanovichi (2000) ArticleTitleLaparoscopic versus open surgery: a preliminary comparison of quality of life outcomes Surg Endosc 14 16–21 Occurrence Handle10.1007/s004649900003 Occurrence Handle10653229

    Article  PubMed  Google Scholar 

  40. V Velanovich R Karmy-Jones (2001) ArticleTitleSurgical management of a paraesophageal hernias: outcome and quality of life analysis Dig Surg 18 432–438 Occurrence Handle10.1159/000050189 Occurrence Handle1:STN:280:DC%2BD38%2Fnt1Cgtg%3D%3D Occurrence Handle11799291

    Article  CAS  PubMed  Google Scholar 

  41. DI Watson N Davies PG Devitt GG Jamieson (1999) ArticleTitleImportance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias Arch Surg 134 1069–1073 Occurrence Handle10.1001/archsurg.134.10.1069 Occurrence Handle1:STN:280:DyaK1MvltVKrsQ%3D%3D Occurrence Handle10522848

    Article  CAS  PubMed  Google Scholar 

  42. RJ Wiechmann MK Ferguson KS Naunheim P McKesey SJ Hazelrigg TS Sanntucci RS Macherey et al. (2001) ArticleTitleLaparoscopic management of giant paraesophageal herniation Ann Thorac Surg 71 1080–1087 Occurrence Handle10.1016/S0003-4975(00)01229-7 Occurrence Handle1:STN:280:DC%2BD3M3kvVCrtw%3D%3D Occurrence Handle11308140

    Article  CAS  PubMed  Google Scholar 

  43. JS Wu DL Dunnegan NJ Soper (1999) ArticleTitleClinical and radiologic assessment of laparoscopic paraesophageal hernia repair Surg Endosc 13 497–502 Occurrence Handle10.1007/s004649901021 Occurrence Handle1:STN:280:DyaK1M3ksVOmtA%3D%3D Occurrence Handle10227951

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital de Sant Pau, Padre Claret 167, 08025, Barcelona, Spain

    E. M. Targarona, J. Novell, S. Vela, G. Cerdán, G. Bendahan, C. Kobus, P. Rebasa, C. Balague, J. Garriga & M. Trias

  2. Department of Radiology, Hospital de Sant Pau, Autonomous University of Barcelona, Padre Claret 167, 08025, Barcelona, Spain

    S. Torrubia

Authors
  1. E. M. Targarona
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Novell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Vela
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Cerdán
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Bendahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Torrubia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Kobus
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Rebasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Balague
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J. Garriga
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. Trias
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. M. Targarona.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Targarona, E.M., Novell, J., Vela, S. et al. Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia. Surg Endosc 18, 1045–1050 (2004). https://doi.org/10.1007/s00464-003-9227-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-003-9227-1

Keywords

Search

Navigation