Revisional paraesophageal hernia repair outcomes compare favorably to initial operations.

Abstract

Recurrent paraesophageal hernia (PEH) repair is performed for symptomatic recurrent hiatal hernia and/or reflux with little understanding as to outcomes related to perioperative and subjective patient variables. The aim of this study was to understand what differences exist between patients undergoing initial paraesophageal hernia (IPEH) repair and those undergoing redo paraesophageal hernia (RPEH) repair. A review of PEH repairs between 2009 and 2013 was performed from a single institution. RPEH patients were identified and analyzed for demographic information, perioperative/intraoperative details, and postoperative outcomes. A similar comparison group of IPEH patients was randomly selected from the same sample as a control. A phone questionnaire was administered to the RPEH group. Among 336 total PEH repairs from 2009 to 2013, 34 RPEH patients were identified. A matched cohort of 76 patients was identified. RPEH and IPEH groups had similar DeMeester score, incidence of Barrett's esophagus, incidence of gastritis, and LOS. Readmission rates (15 vs. 24%, p=0.283) and recurrence rate (4 vs. 12%, p=0.201) were not statistically different between IPEH and RPEH repairs, respectively. Operative times (163 vs. 209min, p<0.001), incidence of Collis gastroplasty (1 vs. 24%, p<0.001), and EBL>10cc (25 vs. 51%, p<0.023) differed between IPEH and RPEH repairs, respectively. Recurrent symptoms included chest pain (37%), solid dysphagia (42%), nausea (58%), vomiting (32%), bloating (63%), and hoarseness (21%). 21% of patients required ongoing antacid therapy. Patient satisfaction via phone questionnaires demonstrated 88% of patients were completely satisfied. Recurrent PEH repair is performed with similar outcomes to IPEH repair with the exception of increased operative time and blood loss. Collis gastroplasty is required more frequently in RPEH patients. Persistent symptoms exist following RPEH repair. Despite recurrent symptomatology, patient satisfaction is high. RPEH repair may be safely performed in patients with recurrent paraesophageal hernias with outcomes similar to IPEH repairs.