Laparoscopic Repair of Large Hiatal Hernia: Impact on Dyspnoea

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2011 Jun 4

PMID 21638174

Citations 15

Authors

Jacqui C Zhu

Guillermo Becerril

Katy Marasovic

Alvin J Ing

Gregory L Falk

Affiliations

Soon will be listed here.

Abstract

Introduction: This study aims to examine the impact of laparoscopic repair of large hiatal hernia on dyspnoea severity, respiratory function and quality of life.

Methods: From 2004 to 2008, 30 consecutive patients with large para-oesophageal hernia defined as >50% of stomach in the intra-thoracic cavity and minimum follow-up of 2 years were included in this study. All patients had a formal respiratory function test 1 week prior and 3 months after their laparoscopic hiatal hernia repair. Patients rated symptom severity and completed a quality-of-life questionnaire [Gastrointestinal Quality of Life Index (GIQLI)] pre-operatively, and post-operatively at 3 months, 6 months and yearly thereafter.

Results: There was no hospital mortality, and the morbidity rate was 10%. In 26 patients with pre-operative dyspnoea, 22 had complete resolution while the remaining 4 had improvement of dyspnoea severity post-operatively. The mean dyspnoea severity index reduced from 2.4 to 1.3 (P < 0.001). Overall, there was 1%, 3% and 3% post-operative increase in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) values for the whole group, none of which reached statistical significance. For patients with resolution or improvement of dyspnoea after laparoscopic repair, no significant change of respiratory function parameters was demonstrated. GIQLI score improved from a pre-operative value of 85.7 to 107.9 post-operatively (P < 0.001).

Conclusions: We failed to show a significant change in post-operative respiratory function despite clearly demonstrated improvement of respiratory symptoms. Alternative explanations for reduction of dyspnoea severity should be sought.

Citing Articles

The effect of surgical repair of hiatal hernia (HH) on pulmonary function: a systematic review and meta-analysis.

Wang Y, Lv Y, Liu Y, Xie C Hernia. 2023; 27(4):839-848.

PMID: 36826630 PMC: 10374806. DOI: 10.1007/s10029-023-02756-5.

Dyspnoea improves following composite repair of giant paraoesophageal hernia.

Khoma O, Wong N, Mugino M, Khoma M, Van der Wall H, Falk G Ann R Coll Surg Engl. 2022; 105(6):523-527.

PMID: 36374275 PMC: 10313459. DOI: 10.1308/rcsann.2022.0124.

New or enlarging hiatal hernias after thoracic surgery for early lung cancer.

Song K, Yip R, Chung M, Cai Q, Zhu Y, Singh A JTCVS Open. 2022; 10:415-423.

PMID: 36004265 PMC: 9390567. DOI: 10.1016/j.xjon.2022.02.013.

Large hiatus hernia: time for a paradigm shift?.

Rajkomar K, Berney C BMC Surg. 2022; 22(1):264.

PMID: 35804332 PMC: 9264491. DOI: 10.1186/s12893-022-01705-w.

Laparoscopic fundoplication for para-oesophageal hernia repair improves respiratory function in patients with dyspnoea: a prospective cohort study.

Bouriez D, Belaroussi Y, Boubaddi M, Martre P, Najah H, Berger P Surg Endosc. 2022; 36(10):7266-7278.

PMID: 35732837 PMC: 9216289. DOI: 10.1007/s00464-022-09127-8.

References

Gurski R, Pereira da Rosa A, Valle E, de Borba M, Valiati A . Extraesophageal manifestations of gastroesophageal reflux disease. J Bras Pneumol. 2007; 32(2):150-60. DOI: 10.1590/s1806-37132006000200011. View

Wolf P, Oelschlager B . Laparoscopic paraesophageal hernia repair. Adv Surg. 2007; 41:199-210. DOI: 10.1016/j.yasu.2007.05.013. View

Aly A, Munt J, Jamieson G, Ludemann R, Devitt P, Watson D . Laparoscopic repair of large hiatal hernias. Br J Surg. 2005; 92(5):648-53. DOI: 10.1002/bjs.4916. View

Sontag S . The spectrum of pulmonary symptoms due to gastroesophageal reflux. Thorac Surg Clin. 2005; 15(3):353-68. DOI: 10.1016/j.thorsurg.2005.04.002. View

ANDUJAR J, Papasavas P, Birdas T, Robke J, Raftopoulos Y, Gagne D . Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc. 2004; 18(3):444-7. DOI: 10.1007/s00464-003-8823-4. View

SENYK J, ARBORELIUS Jr M, Lilja B, OHLSSON N . Respiratory function in esophageal hiatus hernia. I. Spirometry, gas distribution, and arterial blood gases. Respiration. 1975; 32(2):93-102. DOI: 10.1159/000193639. View

Ito H, Kitami M, Ohgi S, Ohe H, Ozoe A, Sasaki H . [Large hiatus hernia compressing the heart and impairing the respiratory function: a case report]. J Cardiol. 2003; 41(1):29-34. View

Khaitan L, Houston H, Sharp K, Holzman M, Richards W . Laparoscopic paraesophageal hernia repair has an acceptable recurrence rate. Am Surg. 2002; 68(6):546-51; discussion 551-2. View

Devbhandari M, Khan M, Hooper T . Cardiac compression following cardiac surgery due to unrecognised hiatus hernia. Eur J Cardiothorac Surg. 2007; 32(5):813-5. DOI: 10.1016/j.ejcts.2007.08.002. View

10.

Harding S, Schan C, Guzzo M, Alexander R, Bradley L, Richter J . Gastroesophageal reflux-induced bronchoconstriction. Is microaspiration a factor?. Chest. 1995; 108(5):1220-7. DOI: 10.1378/chest.108.5.1220. View

11.

Champion G, Richter J . Atypical presentation of gastroesophageal reflux disease: chest pain, pulmonary, and ear, nose, throat manifestations. Gastroenterologist. 1993; 1(1):18-33. View

12.

Buenaventura P, Schauer P, Keenan R, Luketich J . Laparoscopic repair of giant paraesophageal hernia. Semin Thorac Cardiovasc Surg. 2000; 12(3):179-85. DOI: 10.1053/stcs.2000.9785. View

13.

Napierkowski J, Wong R . Extraesophageal manifestations of GERD. Am J Med Sci. 2003; 326(5):285-99. DOI: 10.1097/00000441-200311000-00005. View

14.

Nason K, Luketich J, Qureshi I, Keeley S, Trainor S, Awais O . Laparoscopic repair of giant paraesophageal hernia results in long-term patient satisfaction and a durable repair. J Gastrointest Surg. 2008; 12(12):2066-75. DOI: 10.1007/s11605-008-0712-7. View

15.

Hunt G, Gilchrist D, Hirji M . Cardiac compression and decompensation due to hiatus hernia. Can J Cardiol. 1996; 12(3):295-6. View

16.

Korolija D, Sauerland S, Wood-Dauphinee S, Abbou C, Eypasch E, Garcia Caballero M . Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc. 2004; 18(6):879-97. DOI: 10.1007/s00464-003-9263-x. View

17.

Kounis N, Zavras G, Kitrou M, Soufras G, Constantinidis K . Unusual electrocardiographic manifestations in conditions with increased intrathoracic pressure. Acta Cardiol. 1988; 43(6):653-61. View

18.

Vincent D, Leport J, Merrouche M, Geronimi A, Pradalier A, Soule J . Gastro-oesophageal reflux prevalence and relationship with bronchial reactivity in asthma. Eur Respir J. 1997; 10(10):2255-9. DOI: 10.1183/09031936.97.10102255. View

19.

SENYK J, ARBORELIUS Jr M, Lilja B . Respiratory function in esophageal hiatus hernia. II. Regional lung function. Respiration. 1975; 32(2):103-11. DOI: 10.1159/000193640. View

20.

Pierre A, Luketich J, Fernando H, Christie N, Buenaventura P, Litle V . Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg. 2003; 74(6):1909-15; discussion 1915-6. DOI: 10.1016/s0003-4975(02)04088-2. View