Repair of giant paraesophageal hernias routinely produces improvement in respiratory function.

Abstract

OBJECTIVE:

Assessment of the clinical impact of giant paraesophageal hernias have historically focused on upper gastrointestinal symptoms. This study assesses the effect of paraesophageal hernia repair on respiratory function.

METHODS:

All patients undergoing repair of giant paraesophageal hernia were prospectively entered into a database approved by the institutional review board. Patients had symptoms documented preoperatively, including dyspnea. Pulmonary function tests (PFTs) were done preoperatively and repeated a median of 106 days after repair (range, 16-660 days).

RESULTS:

Preoperative and postoperative PFTs were obtained in 120 unselected patients treated for paraesophageal hernia between 2000 and 2010. Patients' median age was 74 years (range, 45-91 years), 74 (62%) were female, and median body mass index was 28.0 (range, 16.8-46.6). Median length of stay was 4 days (range, 3-10 days), and perioperative mortality was zero. Hernias were classified as type II in 3 (3%) patients, III in 92 (77%), and IV in 25 (21%). Percent of intrathoracic stomach was assigned from preoperative contrast studies and grouped as less than 50% (n = 6; 5%), 50% to 74% (n = 35; 29%), 75% to 99% (n = 29; 24%), and 100% (n = 50; 42%). Preoperative symptoms included heartburn 71 (59%), early satiety 65 (54%), dyspnea 63 (52%), chest pain 48 (40%), dysphagia 56 (47%), regurgitation 47 (39%), and anemia 44 (37%). PFTs significantly improved after paraesophageal hernia repair (mean volume change, percent reference change): forced vital capacity +0.30 L,+10.3%pred; FEV(1) +0.23 L,+10.4%pred (all P < .001); diffusion capacity of the lung for carbon monoxide +0.58 mL · mm Hg(-1) · min(-1) (P = .004), and +2.9%pred (P = .002). Greater improvements were documented in older patients with significant subjective respiratory symptoms and higher percent of intrathoracic stomach (P < .01).

CONCLUSIONS:

Paraesophageal hernia has a significant effect on respiratory function, which is largely underappreciated. This study demonstrates that these repairs can be done safely and supports routine consideration for elective repair; older patients with borderline respiratory function may achieve substantial improvements in their respiratory status and quality of life.

• Authors: Philip W Carrott, Jean Hong, Madhankumar Kuppusamy, Steven Kirtland, Richard P Koehler, Donald E Low
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 143 Issue 2 Pg. 398-404 (Feb 2012) ISSN: 1097-685X [Electronic] United States
• PMID: 22104674 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Digestive System Surgical Procedures (adverse effects)
• Dyspnea (diagnosis, etiology, physiopathology)
• Female
• Forced Expiratory Volume
• Hernia, Hiatal (complications, physiopathology, surgery)
• Humans
• Lung (physiopathology)
• Male
• Middle Aged
• Prospective Studies
• Pulmonary Diffusing Capacity
• Recovery of Function
• Regression Analysis
• Respiratory Function Tests
• Time Factors
• Treatment Outcome
• Vital Capacity
• Washington