Reoperative laparoscopic paraesophageal herniorrhaphy can produce excellent outcomes

Abstract

Patients undergoing laparoscopic paraesophageal herniorrhaphy present with various esophageal and extraesophageal symptoms. Given a recurrence rate of up to 44%, reoperative intervention is necessary on a number of patients. The goal of this study is to determine whether patients proceeding with reoperative laparoscopic paraesophageal herniorrhaphy experienced symptom resolution equal to or better than patients undergoing first-time repair. A frequency-based symptom assessment consisting of 24 esophageal and extraesophageal reflux symptoms was developed and administered pre- and postoperatively to patients undergoing initial or reoperative paraesophageal herniorrhaphy during a 7-year period. A composite score for esophageal and extraesophageal symptoms was calculated. Retrospective analysis of patient records including diagnostic studies, and operative and postoperative progress notes was performed. Data were analyzed using appropriate statistical tests. In 195 patients, 89.9% of patients had resolved or improved individual symptom scores at 6 months postoperatively after primary or reoperative paraesophageal herniorrhaphy. Paraesophageal herniorrhaphy resulted in improvements of both esophageal (16.1±8.5 preoperatively versus 3.5±5.0 at 6 months postoperatively; p<0.001) and extraesophageal (8.6±7.5 preoperatively versus 2.2±5.1 at 6 months postoperatively; p<0.001) composite scores and all individual symptom scores (p<0.05). Preoperatively, patients undergoing reoperative surgery had significantly higher solid dysphagia and abdominal discomfort, but lower odynophagia scores. Furthermore, reoperative patients had significantly lower preoperative composite extraesophageal scores (6.1±7.2 reoperative versus 9.1±7.5 primary; p<0.05) and individual symptom scores in laryngitis, hoarseness, and coughing. Only heartburn in reoperative patients was significantly higher at 12 months postoperatively. Otherwise, there was no significant difference in individual or composite symptom scores between groups postoperatively. All scores had significant improvement postoperatively when compared with preoperative scores. Our data demonstrate that reoperative laparoscopic paraesophageal herniorrhaphy can produce excellent results, comparable to first-time repair.