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Laparoscopic revision paraesophageal hernia repair: a 16-year experience at a single institution

  • 2021 SAGES Oral
  • Published:
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Abstract

Background

Laparoscopic paraesophageal hernia repair (PEHr) is a safe and effective procedure for relieving foregut symptoms associated with paraesophageal hernias (PEH). Nonetheless, it is estimated that about 30–50% of patients will have symptomatic recurrence requiring additional surgical intervention. Revision surgery is technically demanding and may be associated with a higher rate of morbidity and poor patient-reported outcomes. We present the largest study of perioperative and quality-of-life outcomes among patients who underwent laparoscopic revision PEHr.

Methods

A retrospective review of all patients who underwent laparoscopic revision paraesophageal hernia repair between February 2003 and October 2019, at a single institution was conducted. All revisions of Type I hiatal hernias were excluded. The following validated surveys were used to evaluate quality-of-life outcomes: Reflux Symptom Index (RSI) and Gastroesophageal Reflux Disease Health-Related QOL (GERD-HRQL). Patient demographic, perioperative, and quality-of-life (QOL) data were analyzed using univariate analysis.

Results

One hundred ninety patients were included in the final analysis (63.2% female, 90.5% single revision, 9.5% multiple revisions) with a mean age, BMI, and age-adjusted Charlson score of 56.6 ± 14.7 years, 29.7 ± 5.7 kg/m2, and 2.04 ± 1.9, respectively. The study cohort consisted of type II (49.5%), III (46.3%), and IV hiatal hernia (4.2%), respectively. Most patients underwent either a complete (68.7%) or partial (27.7%) fundoplication. A Collis gastroplasty was performed in 14.7% of patients. The median follow-up was 17.6 months. The overall morbidity and mortality rate were 15.8% and 1.1%, respectively. The 30-day readmission rate was 9.5%. Additionally, at latest follow-up 47.9% remained on antireflux medication. At latest follow-up, there was significant improvement in mean RSI score (46.4%, p < 0.001) from baseline within the study population. Furthermore, there was no significant difference in QOL between patients who had a history of an initial repair only or history of revision surgery at latest review. The overall recurrence rate was 16.3% with 6.3% requiring a surgical revision.

Conclusion

Laparoscopic revision PEHr is associated with a low rate of morbidity and mortality. Revision surgery may provide improvement in QOL outcomes, despite the high rate of long-term antireflux medication use. The rate of recurrent paraesophageal hernia remains low with few patients requiring a second revision. However, longer follow-up is needed to better characterize the long-term recurrence rate and symptomatic improvements.

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Funding

No financial support was received for this study.

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Authors and Affiliations

  1. Division of Bariatric and Foregut Surgery, Department of General Surgery, Geisinger Surgery Institute, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, USA

    Alex Addo, Dylan Carmichael, Kelley Chan, Brian Dessify, Gabriel Mekel, Jon D. Gabrielsen, Anthony T. Petrick & David M. Parker

  2. University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, USA

    Andrew Broda

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  1. Alex Addo
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  2. Dylan Carmichael
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  3. Kelley Chan
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  4. Andrew Broda
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  5. Brian Dessify
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  7. Jon D. Gabrielsen
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All authors certify that they accept responsibility as an author and have contributed to the concept, data gathering, analysis, manuscript drafting, and give their final approval.

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Correspondence to Alex Addo.

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Disclosures

Dr. Addo, Parker, Petrick, Gabrielsen, Carmichael, Chan, Mekel, Dessify and Mr. Broda have no conflict of interest or financial or relevant financial ties to disclose.

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This work was given as an oral presentation at SAGES August 31st to September 3rd, 2021, Las Vegas, Nevada.

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Addo, A., Carmichael, D., Chan, K. et al. Laparoscopic revision paraesophageal hernia repair: a 16-year experience at a single institution. Surg Endosc 37, 624–630 (2023). https://doi.org/10.1007/s00464-022-09359-8

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  • DOI: https://doi.org/10.1007/s00464-022-09359-8

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