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| Outcomes After Laparoscopic Giant Paraesophageal Hernia Repair in 636 patients | |
James D. Luketich, Katie S. Nason, Rodney J. Landreneau, Samuel Keeley, Omar Awais, Manisha Shende, Matthew J. Schuchert, Ghulam Abbas, Blair A. Jobe, Arjun Pennathur; The Heart,Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, PITTSBURGH, PA
Methods: A retrospective review of patients undergoing elective LRGPEH (1997-2008) was performed. Clinical outcomes, barium swallow (BaSwa) and quality-of-life (QoL) were assessed Results: LRGPEH was performed in 636 patients (median age 71; range 19-92). The median percent of intrathoracic stomach by BaSwa was 66% (range 30-100%). Hernia reduction, sac resection, crural repair (mesh-reinforcement in 13% (84/636)and fundoplication was performed in 98% (407/636) with Collis-gastroplasty in 63% (407/636). Open conversion rate was 1.4% (9/636). Nine patients (9/636; 1.4%) required re-operation for leaks. Median length of stay (LOS) was 3 days (range 1-63). Pleural effusion (54/636; 9%) and pneumonia (27/636; 4%) were the most common major complications. Mortality was 2% at 30-days (11/636). Post-operative GERD-Health-related QoL scores (30-month median clinical follow-up) were available for 470 patients with “Good” to “Excellent” results in 91% (428/470) of patients (excellent=0-5; good=6-10). Recurrence requiring re-operation occurred in 2.5% (16/636). Overall, surgical result was satisfactory in 92% (432/470) Conclusion: In the largest series to date, LRGPEH was performed in 636 patients with a 1.4% open conversion rate, a 3 day LOS, and 30-day mortality rate of 2%. At 30 months median clinical follow-up, 92% of patients were satisfied with the surgical result. Re-operation for recurrence was required in 2.5%, which is comparable to open series Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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