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Paraesophageal hernia repair: a curative consideration for chronic anemia?

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Chronic anemia is a common, coinciding or presenting diagnosis in patients with paraesophageal hernia (PEH). Presence of endoscopically identified ulcerations frequently prompts surgical consultation in the otherwise asymptomatic patient with anemia. Rates of anemia resolution following paraesophageal hernia repair (PEHR) often exceed the prevalence of such lesions in the study population. A defined algorithm remains elusive. This study aims to characterize resolution of anemia after PEHR with respect to endoscopic diagnosis.

Materials and methods

Retrospective review of a prospectively maintained database of patients with PEH and anemia undergoing PEHR from 2007 to 2018 was performed. Anemia was determined by preoperative labs: Hgb < 12 mg/dl in females, Hgb < 13 mg/dl in males, or patients with ongoing iron supplementation. Improvement of post-operative anemia was assessed by post-operative hemoglobin values and continued necessity of iron supplementation.

Results

Among 56 identified patients, 45 were female (80.4%). Forty patients (71.4%) were anemic by hemoglobin value, 16 patients (28.6%) required iron supplementation. Mean age was 65.1 years, with mean BMI of 27.7 kg/m2. One case was a Type IV PEH and the rest Type III. 32 (64.0%) had potential source of anemia: 16 (32.0%) Cameron lesions, 6 (12.0%) gastric ulcers, 12 (24.0%) gastritis. 10 (20.0%) had esophagitis and 4 (8%) Barrett’s esophagus. 18 (36%) PEH patients had normal preoperative EGD. Median follow-up was 160 days. Anemia resolution occurred in 46.4% of patients. Of the 16 patients with pre-procedure Cameron lesions, 10 (63%) had resolution of anemia. Patients with esophagitis did not achieve resolution. 72.2% (13/18) of patients with no lesions on EGD had anemia resolution (p = 0.03).

Conclusion

Patients with PEH and identifiable ulcerations showed 50% resolution of anemia after hernia repair. Patients without identifiable lesions on endoscopy demonstrated statistically significant resolution of anemia in 72.2% of cases. Anemia associated with PEH adds an indication for surgical repair with curative intent.

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References

  1. Dangleben DA, Du C (2017) Paraesophageal hernia. Acute Care Gen Surg 95(3):101–106. https://doi.org/10.1016/j.suc.2015.02.008

    Article  Google Scholar 

  2. Haurani C, Carlin AM, Hammoud ZT, Velanovich V (2012) Prevalence and resolution of anemia with paraesophageal hernia repair. J Gastrointest Surg 16(10):1817–1820

    Article  Google Scholar 

  3. Fiorini G, Lahner E, Annibale B, Zullo A, De Francesco V, Vaira D et al (2018) Cameron lesions: a still overlooked diagnosis Case report and systematic review of literature. Clin Res Hepatol Gastroenterol 42(6):604–609. https://doi.org/10.1016/j.clinre.2018.05.002

    Article  PubMed  Google Scholar 

  4. Wideman TH, Zautra AJ, Edwards RR (2014) Re-thinking the fear avoidance model: toward a multi-dimensional framework of pain-related disability. NIH Public Access 154(11):2262–2265

    Google Scholar 

  5. Maganty K, Smith RL (2008) Cameron lesions: unusual cause of gastrointestinal bleeding and anemia. Digestion 77(3–4):214–217

    Article  Google Scholar 

  6. Carrott PW, Hong J, Kuppusamy M, Koehler RP, Low DE (2012) Clinical ramifications of giant paraesophageal hernias are underappreciated: Making the case for routine surgical repair. Ann Thorac Surg 94(2):421–428. https://doi.org/10.1016/j.athoracsur.2012.04.058

    Article  PubMed  Google Scholar 

  7. Velanovich V, Karmy-Jones R (2003) Surgical Management of paraesophageal hernias: outcome and quality of life analysis/with invited commentary. Dig Surg 18(6):432–438

    Article  Google Scholar 

  8. Skipworth RJE, Staerkle RF, Leibman S, Smith GS (2014) Transfusion-dependent anaemia: an overlooked complication of paraoesophageal hernias. Int Sch Res Not 2014:1–4

    Article  Google Scholar 

  9. Hayden H, Jamieson J (2005) Diseases of the esophagus effect on iron deficiency anemia of laparoscopic repair of large paraesophageal hernias. Dis Esophagus 18(5):329–331

    Article  CAS  Google Scholar 

  10. Ruhl CE, Everhart JE (2001) Relationship of iron-deficiency anemia with esophagitis and hiatal hernia: hospital findings from a prospective, population-based study. Am J Gastroenterol 96(2):322–326

    Article  CAS  Google Scholar 

  11. Windsor CW, Collis JL (1967) Anaemia and hiatus hernia: experience in 450 patients. Thorax 22(1):73–78

    Article  CAS  Google Scholar 

  12. Carrott PW, Markar SR, Hong J, Kuppusamy MK, Koehler RP, Low DE (2013) Iron-deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair. J Gastrointest Surg 17(5):858–862

    Article  Google Scholar 

  13. Eubanks TR, Pellegrini CA, Jacobsen G, Horgan S, Omelanczuk P (2002) Repair of paraesophageal hernias. Am J Surg 177(5):354–358

    Google Scholar 

  14. Trastek VF, Allen MS, Deschamps C, Pairolero PC, Thompson A, Altorki N (1996) Diaphragmatic hernia and associated anemia: response to surgical treatment. J Thorac Cardiovasc Surg 112(5):1340–1345

    Article  CAS  Google Scholar 

  15. Chevrollier GS, Brown AM, Keith SW, Szewczyk J, Pucci MJ, Chojnacki KA et al (2019) Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair. Surg Endosc. 33(2):535–542. https://doi.org/10.1007/s00464-018-6328-4

    Article  PubMed  Google Scholar 

  16. Zuckerman GR, Prakash C, Askin MP, Lewis BS (2000) AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 118(1):201–221

    Article  CAS  Google Scholar 

  17. Delle Fave G, Annibale B, Di Giulio E, Capurso G, Baccini F, Panzuto F et al (2004) Large hiatal hernia in patients with iron deficiency anaemia: a prospective study on prevalence and treatment. Aliment Pharmacol Ther 19(6):663–670

    Article  Google Scholar 

  18. El Khoury R, Ramirez M, Hungness ES, Soper NJ, Patti MG (2015) Symptom relief after laparoscopic paraesophageal hernia repair without mesh. J Gastrointest Surg 19(11):1938–1942

    Article  Google Scholar 

  19. D’Ambra G, Fave GD, Lahner E, Capurso G, Di Giulio E, Annibale B et al (2003) Role of small bowel investigation in iron deficiency anaemia after negative endoscopic/histologic evaluation of the upper and lower gastrointestinal tract. Dig Liver Dis 35(11):784–787

    Article  Google Scholar 

  20. Karmali S, McFadden S, Mitchell P, Graham A, Debru E, Gelfand G et al (2008) Primary laparoscopic and open repair of paraesophageal hernias: a comparison of short-term outcomes. Dis Esophagus 21(1):63–68

    Article  CAS  Google Scholar 

  21. Hinojosa MW, Reavis KM, Parikh D, Varela E, Nguyen NT (2012) Utilization and outcomes of laparoscopic versus open paraesophageal hernia repair. Am Surg 2014:90035

    Google Scholar 

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive MC 0740, La Jolla, San Diego, CA, 92093-0740, USA

    Joslin N. Cheverie, Jenny Lam, Kai Neki, Ryan C. Broderick, Arielle M. Lee, Tokio Matsuzaki, Robert Cubas, Bryan J. Sandler, Garth R. Jacobsen, Karl-Hermann Fuchs & Santiago Horgan

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  1. Joslin N. Cheverie
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  2. Jenny Lam
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  3. Kai Neki
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  4. Ryan C. Broderick
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  5. Arielle M. Lee
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  6. Tokio Matsuzaki
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  7. Robert Cubas
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  8. Bryan J. Sandler
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  9. Garth R. Jacobsen
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  10. Karl-Hermann Fuchs
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  11. Santiago Horgan
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Corresponding author

Correspondence to Arielle M. Lee.

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Disclosures

Dr. Horgan has stock options with TORAX™ Medical Inc. Dr. Jacobsen has two grants with TORAX™ Medical Inc, the first for The CALIBER Study: Randomized Controlled Trial of LINX versus Double-Dose Proton Pump Inhibitor Therapy for Reflux Disease, and the second for A Post-Approval Study of the LINX®Reflux management system. Drs. Cheverie, Broderick, Lam, Lee, Neki, Matsuzaki, Cubas, Sandler, and Fuchs have no conflicts of interest or financial ties to disclose.

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Cheverie, J.N., Lam, J., Neki, K. et al. Paraesophageal hernia repair: a curative consideration for chronic anemia?. Surg Endosc 34, 2243–2247 (2020). https://doi.org/10.1007/s00464-019-07014-3

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  • DOI: https://doi.org/10.1007/s00464-019-07014-3

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