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Paraesophageal hernia recurrence following repair: making the case for reoperative surgery in a propensity-matched cohort

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Abstract

Background

Paraesophageal hernia repairs (PEHRs) have high rates of radiographic recurrence, with some patients requiring repeat operation. This study characterizes patients who underwent PEHR to identify the factors associated with postoperative symptom improvement and radiographic recurrence. We furthermore use propensity score matching to compare patients undergoing initial and reoperative PEHR to identify the factors predictive of recurrence or need for reoperation.

Methods

After IRB approval, patients who underwent PEHR at a tertiary care center between January 2018 and December 2022 were identified. Patient characteristics, preoperative imaging, operative findings, and postoperative outcomes were recorded. A computational generalization of inverse propensity score weight was then used to construct populations of initial and redo PEHR patients with similar covariate distributions.

Results

A total of 244 patients underwent PEHR (78.7% female, mean age 65.4 ± 12.3 years). Most repairs were performed with crural closure (81.4%) and fundoplication (71.7%) with 14.2% utilizing mesh. Postoperatively, 76.5% of patients had subjective symptom improvement and of 157 patients with postoperative imaging, 52.9% had evidence of radiographic recurrence at a mean follow-up of 10.4 ± 13.6 months. Only 4.9% of patients required a redo operation. Hernia type, crural closure, fundoplication, and mesh usage were not predictors of radiographic recurrence or symptom improvement (P > 0.05). Propensity weight score analysis of 50 redo PEHRs compared to a matched cohort of 194 initial operations revealed lower rates of postoperative symptom improvement (P < 0.05) but no differences in need for revision, complication rates, ED visits, or readmissions.

Conclusions

Most PEHR patients have symptomatic improvement with minimal complications and reoperations despite frequent radiographic recurrence. Hernia type, crural closure, fundoplication, and mesh usage were not significantly associated with recurrence or symptom improvement. Compared to initial PEHR, reoperative PEHRs had lower rates of symptom improvement but similar rates of recurrence, complications, and need for reoperation.

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Funding

Mr. Aditya Jog received research funding from the Harrison/Measey Scholars program.

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Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Aditya Jog

  2. Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA

    Alexandra L. Strauss Starling

  3. University of Pennsylvania, Philadelphia, PA, USA

    Isha Kaur & Kenneth Um

  4. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Luke J. Keele & Maria S. Altieri

  5. Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Joseph R. Triggs

  6. Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, 2926A Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA

    Jenny M. Shao

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  1. Aditya Jog
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  3. Isha Kaur
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Correspondence to Jenny M. Shao.

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Disclosures

Dr. Shao receives consulting honoraria from Abbvie Inc. Drs. Strauss, Keele, Triggs, and Altieri have no conflict of interest to disclose. Mr. Jog, Mr. Um, and Ms. Kaur have no conflict of interest or financial ties to disclose.

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Jog, A., Strauss Starling, A.L., Kaur, I. et al. Paraesophageal hernia recurrence following repair: making the case for reoperative surgery in a propensity-matched cohort. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10833-8

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