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Esophageal Motility Patterns in Paraesophageal Hernia Patients Compared to Sliding Hiatal Hernia: Bigger Is Not Better

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

In patients with paraesophageal hernias (PEH), the course of the esophagus is often altered, which may affect esophageal motility. High-resolution manometry (HRM) is frequently used to evaluate esophageal motor function prior to PEH repair. This study was performed to characterize esophageal motility disorders in patients with PEH as compared to sliding hiatal hernia and to determine how these findings affect operative decision-making.

Methods

Patients referred for HRM to a single institution from 2015 to 2019 were included in a prospectively maintained database. HRM studies were analyzed for the appearance of any esophageal motility disorder using the Chicago classification. PEH patients had confirmation of their diagnosis at the time of surgery, and the type of fundoplication performed was recorded. They were case-matched based on sex, age, and BMI to patients with sliding hiatal hernia who were referred for HRM in the same period.

Results

There were 306 patients diagnosed with a PEH who underwent repair. When compared to case-matched sliding hiatal hernia patients, PEH patients had higher rates of ineffective esophageal motility (IEM) (p<.001) and lower rates of absent peristalsis (p=.048). Of those with ineffective motility (n=70), 41 (59%) had a partial or no fundoplication performed during PEH repair.

Conclusion

PEH patients had higher rates of IEM compared to controls, possibly due to a chronically distorted esophageal lumen. Offering the appropriate operation hinges on understanding the involved anatomy and esophageal function of each individual. HRM is important to obtain preoperatively for optimizing patient and procedure selection in PEH repair.

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Authors and Affiliations

  1. Department of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA

    Rachel Sillcox, Rocio Carrera, Andrew S Wright, Brant K Oelschlager, Robert B Yates & Roger P Tatum

  2. Department of Surgery, VA Puget Sound HCS, University of Washington, Seattle, WA, USA

    Roger P Tatum

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  1. Rachel Sillcox
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Contributions

Dr. Sillcox contributed to the acquisition and analysis and design of the work, drafted the work, approved the final version, and agreed to be accountable for all aspects of the work.

Dr. Carrera contributed to the acquisition and design of the work, revised the work, approved the final version, and agreed to be accountable for all aspects of the work.

Dr. Wright contributed to the conception and design of the work, revised the work, approved the final version, and agreed to be accountable for all aspects of the work.

Dr. Oelschlager contributed to the conception and design of the work, revised the work, approved the final version, and agreed to be accountable for all aspects of the work.

Dr. Yates contributed to the conception and design of the work, revised the work, approved the final version, and agreed to be accountable for all aspects of the work.

Dr. Tatum contributed to the conception and design of the work, revised the work, approved the final version, and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Rachel Sillcox.

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This work was presented as “Esophageal motility patterns in paraesophageal hiatus hernia” at Digestive Diseases Week 2022, San Diego, California.

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Sillcox, R., Carrera, R., Wright, A.S. et al. Esophageal Motility Patterns in Paraesophageal Hernia Patients Compared to Sliding Hiatal Hernia: Bigger Is Not Better. J Gastrointest Surg 27, 2039–2044 (2023). https://doi.org/10.1007/s11605-023-05754-1

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