Health-related quality of life after laparoscopic repair of giant paraesophageal hernia: how does recurrence in CT scan compare to clinical success?

Henriikka Hietaniemi,Saana Andersson,Harri Sintonen,Juha Kauppi,Jari Räsänen,Ilkka Ilonen,Tommi Järvinen

doi:10.1186/s12893-020-00772-1

Henriikka Hietaniemi, Saana Andersson + Show 5 more

Open Access

https://doi.org/10.1186/s12893-020-00772-1

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Journal: BMC Surgery	Publication Date: May 20, 2020
Citations: 1	License type: open-access

Affiliation: Helsinki University Hospital, University of Helsinki

Abstract

BackgroundComputed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up. We performed a cross-sectional observational study to assess mid-term outcomes of elective laparoscopic GPEH repair. The primary objective of the study was to evaluate the radiological hernia recurrence rate by CT and to determine its association with current symptoms and quality of life.MethodsAll non-emergent laparoscopic GPEH repairs between 2010 to 2015 were identified from hospital medical records. Each patient was offered non-contrast CT and sent questionnaires for disease-specific symptoms and health-related quality of life.ResultsThe inclusion criteria were met by 165 patients (74% female, mean age 67 years). Total recurrence rate was 29.3%. Major recurrent hernia (> 5 cm) was revealed by CT in 4 patients (4.3%). Radiological findings did not correlate with symptom-related quality of life. Perioperative mortality occurred in 1 patient (0.6%). Complications were reported in 27 patients (16.4%).ConclusionsSuccessful laparoscopic repair of GPEH requires both expertise and experience. It appears to lead to effective symptom relief with high patient satisfaction. However, small radiological recurrences are common but do not affect postoperative symptom-related patient wellbeing.

Highlights

Computed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up
The term giant paraesophageal hernia (GPEH) is used when at least one third of the stomach is situated above the diaphragm
A total of 227 patients underwent laparoscopic repair of paraesophageal hernia between 2010 and 2015. Both planned and converted, patients who had been previously operated on (n = 29), emergency operations (n = 20), patients with non-giant paraesophageal hernia (n = 9) and 4 patients who had been operated at a regional hospital

Summary

Introduction

Computed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up. We performed a cross-sectional observational study to assess mid-term outcomes of elective laparoscopic GPEH repair. The term giant paraesophageal hernia (GPEH) is used when at least one third of the stomach is situated above the diaphragm. Hietaniemi et al BMC Surgery (2020) 20:109 has been reported to be 16.4% for conservative treatment [6], while mortality after emergency operations is higher than after elective surgery [7]. Complex laparoscopic repair of GPEH has been reported to be safe and successful [13,14,15] and the postoperative length of stay is shorter and postoperative pain is less severe than after open surgery [11, 16]. Radiological evidence of recurrence after laparoscopic surgery is often higher than after open repair [17]

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