Abstract
IntroductionComparison of elective laparoscopic repair of axial vs paraesophageal hiatal hernias reveals relevant differences in both the patient collectives and the complexity of the procedures.Materials and methodsThe present uni- and multivariable analysis of data from the Herniamed Registry compares the outcome for 2047 (67.3%) (type I) axial with 996 (32.7%) (types II–IV) paraesophageal primary hiatal hernias following laparoscopic repair.ResultsCompared with the patients with axial hiatal hernias, patients with paraesophageal hiatal hernia were nine years older, had a higher ASA score (ASA III/IV: 34.8 vs 13.7%; p < 0.001), and more often at least one risk factor (38.8 vs 21.4%; p < 0.001). This led in the univariable analysis to significantly more general postoperative complications (6.0 vs 3.0%; p < 0.001). Reflecting the greater complexity of the procedures used for laparoscopic repair of paraesophageal hiatal hernias, significantly higher intraoperative organ injury rates (3.7 vs 2.3%; p = 0.033) and higher postoperative complication-related reoperation rates (2.1 vs 1.1%; p = 0.032) were identified. Univariable analysis did not reveal any significant differences in the recurrence and pain rates on one-year follow-up. Multivariable analysis did not find any evidence that the use of a mesh had a significant influence on the recurrence rate.ConclusionSurgical repair of paraesophageal hiatal hernia calls for an experienced surgeon as well as for corresponding intensive medicine competence because of the higher risks of general and surgical postoperative complications.
Highlights
Comparison of elective laparoscopic repair of axial vs paraesophageal hiatal hernias reveals relevant differences in both the patient collectives and the complexity of the procedures
Axial or sliding hernia, in which the gastroesophageal junction migrates into the thorax, is the most common type of hiatal hernia (95%) and may predispose to gastroesophageal reflux [1]
Patients with axial hiatal hernia and reflux disease compared with patients with paraesophageal hiatal hernia were on average more than nine years younger, had a somewhat lower body mass index (BMI), markedly shorter procedure time, and smaller hernia defects (Table 2)
Summary
Surgical repair of paraesophageal hiatal hernia calls for an experienced surgeon as well as for corresponding intensive medicine competence because of the higher risks of general and surgical postoperative complications. Laparoscopic hiatal hernia repair is as effective as open transabdominal repair, with a reduced rate of perioperative morbidity and with shorter hospital stays. There is only one publication with a large case series which compares the patient collective, treatment, and the outcome of laparoscopic repair of type I hiatal hernias with those of paraesophageal hiatal hernias (types II–IV) [18]. Most of the complications occurred in patients with paraesophageal compared with axial hernia (10 vs 1%, respectively) [18] This variation reflects significant differences between patients with axial hiatal hernia, and gastroesophageal reflux disease, and those with paraesophageal hernia; it highlights the increased complexity of the laparoscopic repair procedure used for paraesophageal hernia [18]. Based on data from the Herniamed Hernia Registry, this paper explores the differences between these patients in terms of demographic characteristics, treatment, and outcome
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