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Resolution of anemia and improved quality of life following laparoscopic hiatal hernia repair.

Abstract

BACKGROUND

Cameron lesions (CL) are common complications of large hiatal hernia (HH) disease and are known to result in chronic blood loss with resultant microcytic anemia. There is support in the literature that repair of HH may lead to resolution of CL and restore normal hemoglobin levels. This study aimed to determine the impact of elective HH repair on resolution of anemia and the quality of life (QOL) in patients with CL.

METHOD

A single-institution, retrospective review analyzed all patients with history of CL or anemia (hemoglobin < 12.0 gm/dl in women, < 13.5 gm/dl in men) who underwent HH repair from January 2012 to May 2019. Four validated surveys were used to assess QOL: Reflux Symptom Index (RSI), gastroesophageal reflux disease health-related QOL (GERD-HRQL), laryngopharyngeal reflux health-related QOL (LPR-HRQL), and QOL and swallowing disorders (SWAL) survey. History of iron supplements and perioperative hemoglobin were also noted.

RESULT

Ninety-six patients were included in this study. The mean age was 67.4 ± 10.8 years and 79% of patients were female. CL were endoscopically identified in 61.5% of patients preoperatively, and the rest of the patients experienced anemia of undiagnosed origin but had a high suspicion for CL. Mean follow-up after HH repair was 17.3 months (range, 1 month-5 years). Mean preoperative hemoglobin was 11.01 ± 2.9 gm/dl and 13.23 ± 1.6 gm/dl postoperatively (p < 0.01). Forty-two (73.7%) patients had resolution of anemia during follow-up and 94.5% stopped supplemental oral iron. Finally, QOL scores significantly improved after surgical intervention: RSI (63%), GERD-HRQL (77%), LPR-HRQOL (72%), and SWAL (13%).

CONCLUSION

Elective HH repair in patients with chronic anemia secondary to CL may potentially resolve CL and anemia and contribute to significant QOL improvements. Future studies will prospectively assess the resolution of CL with biochemical and endoscopic follow-up to confirm the preliminary findings of our analysis.

Authors+Show Affiliations

Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA.Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA.Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA.Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA.Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA. apark@aahs.org. Johns Hopkins University School of Medicine, Baltimore, USA. apark@aahs.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31399944

Citation

Addo, Alex, et al. "Resolution of Anemia and Improved Quality of Life Following Laparoscopic Hiatal Hernia Repair." Surgical Endoscopy, 2019.
Addo A, Broda A, Reza Zahiri H, et al. Resolution of anemia and improved quality of life following laparoscopic hiatal hernia repair. Surg Endosc. 2019.
Addo, A., Broda, A., Reza Zahiri, H., Brooks, I. M., & Park, A. (2019). Resolution of anemia and improved quality of life following laparoscopic hiatal hernia repair. Surgical Endoscopy, doi:10.1007/s00464-019-07054-9.
Addo A, et al. Resolution of Anemia and Improved Quality of Life Following Laparoscopic Hiatal Hernia Repair. Surg Endosc. 2019 Aug 9; PubMed PMID: 31399944.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resolution of anemia and improved quality of life following laparoscopic hiatal hernia repair. AU - Addo,Alex, AU - Broda,Andrew, AU - Reza Zahiri,H, AU - Brooks,Ian M, AU - Park,Adrian, Y1 - 2019/08/09/ PY - 2019/04/29/received PY - 2019/07/31/accepted PY - 2019/8/11/entrez KW - Anemia resolution KW - Antireflux surgery KW - Cameron’s lesions KW - Fundoplication KW - Hiatal hernia KW - Hiatal hernia repair KW - Paraesophageal hernia KW - Quality of life outcomes JF - Surgical endoscopy JO - Surg Endosc N2 - BACKGROUND: Cameron lesions (CL) are common complications of large hiatal hernia (HH) disease and are known to result in chronic blood loss with resultant microcytic anemia. There is support in the literature that repair of HH may lead to resolution of CL and restore normal hemoglobin levels. This study aimed to determine the impact of elective HH repair on resolution of anemia and the quality of life (QOL) in patients with CL. METHOD: A single-institution, retrospective review analyzed all patients with history of CL or anemia (hemoglobin < 12.0 gm/dl in women, < 13.5 gm/dl in men) who underwent HH repair from January 2012 to May 2019. Four validated surveys were used to assess QOL: Reflux Symptom Index (RSI), gastroesophageal reflux disease health-related QOL (GERD-HRQL), laryngopharyngeal reflux health-related QOL (LPR-HRQL), and QOL and swallowing disorders (SWAL) survey. History of iron supplements and perioperative hemoglobin were also noted. RESULT: Ninety-six patients were included in this study. The mean age was 67.4 ± 10.8 years and 79% of patients were female. CL were endoscopically identified in 61.5% of patients preoperatively, and the rest of the patients experienced anemia of undiagnosed origin but had a high suspicion for CL. Mean follow-up after HH repair was 17.3 months (range, 1 month-5 years). Mean preoperative hemoglobin was 11.01 ± 2.9 gm/dl and 13.23 ± 1.6 gm/dl postoperatively (p < 0.01). Forty-two (73.7%) patients had resolution of anemia during follow-up and 94.5% stopped supplemental oral iron. Finally, QOL scores significantly improved after surgical intervention: RSI (63%), GERD-HRQL (77%), LPR-HRQOL (72%), and SWAL (13%). CONCLUSION: Elective HH repair in patients with chronic anemia secondary to CL may potentially resolve CL and anemia and contribute to significant QOL improvements. Future studies will prospectively assess the resolution of CL with biochemical and endoscopic follow-up to confirm the preliminary findings of our analysis. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/31399944/Resolution_of_anemia_and_improved_quality_of_life_following_laparoscopic_hiatal_hernia_repair L2 - https://dx.doi.org/10.1007/s00464-019-07054-9 DB - PRIME DP - Unbound Medicine ER -