Abstract
Background and Objectives: Surgical repair of hiatal and paraesophageal hernia is widely accepted for the treatment of gastroesophageal reflux symptoms. The respiratory benefit of this surgery is less clear. The objective of this review is to quantify the benefit to pulmonary function and subjective dyspnea of paraesophageal hernia repair with the aim of refining the indications and contraindications for elective paraesophageal hernia repair.Methods: Articles were gathered from systematic searches of the Medline Complete Database via the Creighton University Health Sciences Library literature search services. Publications with both pre and postoperative pulmonary function data or both pre and postoperative subjective dyspnea data with regards to surgical paraesophageal hernia repair were included.Results: Six studies were included in this review. The majority of studies in this review show improvement in pulmonary function postoperatively with regards to FEV1, FVC, and VC when stratified by % intrathoracic stomach (ITS), particularly in groups >50% ITS. No significant change was seen in postoperative DLCO or FEV1/FVC.Conclusion: Paraesophageal hernia repair has shown to improve pulmonary function both objectively and subjectively. This review was limited by the paucity of literature on the subject as well as the lack of a standardized method for measurement of %ITS.
Highlights
Paraesophageal hernias are defined as herniation of the abdominal contents into the thorax through the esophageal hiatus
Pathological manifestations of paraesophageal hernias include the displacement of the gastroesophageal (GE) junction superior to the diaphragm, herniation of the gastric fundus superior to the diaphragm with the GE junction remaining in place, a combination of GE junction and fundus displacement, and lastly the herniation of additional organs superior to the diaphragm (2)
The first focused on paraesophageal hernia repair and pulmonary function tests and returned seven results
Summary
Paraesophageal hernias are defined as herniation of the abdominal contents into the thorax through the esophageal hiatus. Pathological manifestations of paraesophageal hernias include the displacement of the gastroesophageal (GE) junction superior to the diaphragm (type I or sliding), herniation of the gastric fundus superior to the diaphragm with the GE junction remaining in place (type II), a combination of GE junction and fundus displacement (type III), and lastly the herniation of additional organs superior to the diaphragm (type IV) (2). Include: remaining asymptomatic, gastroesophageal reflux disease (GERD), early satiety, pain after meals, Cameron’s ulcers, iron-deficiency anemia, more rarely, gastric volvulus, and respiratory complications due to compression of the lungs (3). Surgical intervention may be indicated for paraesophageal hernias. Surgical repair of hiatal and paraesophageal hernia is widely accepted for the treatment of gastroesophageal reflux symptoms. The objective of this review is to quantify the benefit to pulmonary function and subjective dyspnea of paraesophageal hernia repair with the aim of refining the indications and contraindications for elective paraesophageal hernia repair
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