Long-Term Follow-Up of Giant Paraesophageal Hernia Repair With Restoration of Normal Anatomy Without Fundoplication.

Abstract

While some have reported performing gastropexy after paraesophageal hernia repair, the risk for development of severe reflux is being defined. Although we have observed good short-term outcomes after restoration of normal anatomy in patients with predominantly obstructive symptoms, long-term outcomes are unknown. Retrospective review of patients without significant reflux (heartburn, regurgitation, pulmonary symptoms) who underwent normal anatomy restoration was performed. Standard minimally invasive paraesophageal hernia repair was performed, then the short gastric line was sutured to the left hemidiaphragm to restore normal anatomy. Patients with follow-up >3 years were included. A recurrence was defined as hernia size >2 cm or >10% of the stomach reherniated. There were 81 patients. Elective repair was performed in 55 (67.9%) patients, with urgent repair performed in 25 (32.1%) patients. All procedures were performed minimally invasively with median postoperative length of stay of 4 days. At a median follow-up of 5.4 years (range, 3.0-15.4 years), obstructive symptom relief persisted. A recurrent hiatal hernia was present in 15 patients (18.5%). Reoperation was required in 1 patient after a forceful vomiting episode. There were 7 patients who reported heartburn with symptoms well controlled by antisecretory medications. No patient required reoperation for severe reflux. Long-term follow-up in patients with giant paraesophageal hernia who underwent restoration of normal anatomy had good symptomatic outcome without significant reflux. Hiatal hernias were common but most were asymptomatic. This approach may avoid the morbidity of fundoplication in carefully selected patients.