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Percentage of intrathoracic stomach predicts operative and post-operative morbidity, persistent reflux and PPI requirement following laparoscopic hiatus hernia repair and fundoplication.
Surg Endosc. 2023 03; 37(3):1994-2002.SE

Abstract

PURPOSE

Large hiatus hernias are relatively common and can be associated with adverse symptoms and serious complications. Operative repair is indicated in this patient group for symptom management and the prevention of morbidity. This study aimed to identify predictors of poor outcomes following laparoscopic hiatus hernia repair and fundoplication (LHHRaF) to aid in counselling potential surgical candidates.

METHODOLOGY

A retrospective analysis was performed from a prospectively maintained, multicentre database of patients who underwent LHHRaF between 2014 and 2020. Revision procedures were excluded. Hernia size was defined as the intraoperative percentage of intrathoracic stomach, estimated by the surgeon to the nearest 10%. Predictors of outcomes were determined using a prespecified multivariate logistic regression model.

RESULTS

625 patients underwent LHHRaF between 2014 and 2020 with 443 patients included. Median age was 65 years, 62.9% were female and 42.7% of patients had ≥ 50% intrathoracic stomach. In a multivariate regression model, intrathoracic stomach percentage was predictive of operative complications (P = 0.014, OR 1.05), post-operative complications (P = 0.026, OR 1.01) and higher comprehensive complication index score (P = 0.023, OR 1.04). At 12 months it was predictive of failure to improve symptomatic reflux (P = 0.008, OR 1.02) and persistent PPI requirement (P = 0.047, OR 1.02). Operative duration and blood loss were predicted by BMI (P = 0.004 and < 0.001), Type III/IV hernias (P = 0.045 and P = 0.005) and intrathoracic stomach percentage (P = 0.009 and P < 0.001). Post-operative length of stay was predicted by age (P < 0.001) and emergency presentation (P = 0.003).

CONCLUSION

In a multivariate regression model, intrathoracic stomach percentage was predictive of operative and post-operative morbidity, PPI use, and failure to improve reflux symptoms at 12 months.

Links

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Authors+Show Affiliations

Cocco AM
The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia. anthonycocco02@gmail.com. Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia. anthonycocco02@gmail.com.
Chai V
Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia.
Read M
The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia.
Ward S
Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, Eastern Health, Melbourne, Australia.
Johnson MA
The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, Eastern Health, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, The Royal Melbourne Hospital, Melbourne, Australia.
Chong L
The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia.
Gillespie C
Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia.
Hii MW
The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, Eastern Health, Melbourne, Australia. Upper GI and Hepatobiliary Surgical Unit, The Royal Melbourne Hospital, Melbourne, Australia.

MeSH

HumansMaleFemaleAgedAged, 80 and overRetrospective StudiesFundoplicationLaparoscopyGastroesophageal RefluxHerniorrhaphyHernia, HiatalPostoperative ComplicationsBlood Loss, SurgicalFollow-Up Studies

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

36278994

Citation

Cocco, A M., et al. "Percentage of Intrathoracic Stomach Predicts Operative and Post-operative Morbidity, Persistent Reflux and PPI Requirement Following Laparoscopic Hiatus Hernia Repair and Fundoplication." Surgical Endoscopy, vol. 37, no. 3, 2023, pp. 1994-2002.
Cocco AM, Chai V, Read M, et al. Percentage of intrathoracic stomach predicts operative and post-operative morbidity, persistent reflux and PPI requirement following laparoscopic hiatus hernia repair and fundoplication. Surg Endosc. 2023;37(3):1994-2002.
Cocco, A. M., Chai, V., Read, M., Ward, S., Johnson, M. A., Chong, L., Gillespie, C., & Hii, M. W. (2023). Percentage of intrathoracic stomach predicts operative and post-operative morbidity, persistent reflux and PPI requirement following laparoscopic hiatus hernia repair and fundoplication. Surgical Endoscopy, 37(3), 1994-2002. https://doi.org/10.1007/s00464-022-09701-0
Cocco AM, et al. Percentage of Intrathoracic Stomach Predicts Operative and Post-operative Morbidity, Persistent Reflux and PPI Requirement Following Laparoscopic Hiatus Hernia Repair and Fundoplication. Surg Endosc. 2023;37(3):1994-2002. PubMed PMID: 36278994.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percentage of intrathoracic stomach predicts operative and post-operative morbidity, persistent reflux and PPI requirement following laparoscopic hiatus hernia repair and fundoplication. AU - Cocco,A M, AU - Chai,V, AU - Read,M, AU - Ward,S, AU - Johnson,M A, AU - Chong,L, AU - Gillespie,C, AU - Hii,M W, Y1 - 2022/10/24/ PY - 2022/02/23/received PY - 2022/10/02/accepted PY - 2022/10/25/pubmed PY - 2023/3/21/medline PY - 2022/10/24/entrez KW - Fundoplication KW - Hiatus hernia repair KW - Laparoscopic KW - Morbidity KW - Oesophageal KW - Reflux SP - 1994 EP - 2002 JF - Surgical endoscopy JO - Surg Endosc VL - 37 IS - 3 N2 - PURPOSE: Large hiatus hernias are relatively common and can be associated with adverse symptoms and serious complications. Operative repair is indicated in this patient group for symptom management and the prevention of morbidity. This study aimed to identify predictors of poor outcomes following laparoscopic hiatus hernia repair and fundoplication (LHHRaF) to aid in counselling potential surgical candidates. METHODOLOGY: A retrospective analysis was performed from a prospectively maintained, multicentre database of patients who underwent LHHRaF between 2014 and 2020. Revision procedures were excluded. Hernia size was defined as the intraoperative percentage of intrathoracic stomach, estimated by the surgeon to the nearest 10%. Predictors of outcomes were determined using a prespecified multivariate logistic regression model. RESULTS: 625 patients underwent LHHRaF between 2014 and 2020 with 443 patients included. Median age was 65 years, 62.9% were female and 42.7% of patients had ≥ 50% intrathoracic stomach. In a multivariate regression model, intrathoracic stomach percentage was predictive of operative complications (P = 0.014, OR 1.05), post-operative complications (P = 0.026, OR 1.01) and higher comprehensive complication index score (P = 0.023, OR 1.04). At 12 months it was predictive of failure to improve symptomatic reflux (P = 0.008, OR 1.02) and persistent PPI requirement (P = 0.047, OR 1.02). Operative duration and blood loss were predicted by BMI (P = 0.004 and < 0.001), Type III/IV hernias (P = 0.045 and P = 0.005) and intrathoracic stomach percentage (P = 0.009 and P < 0.001). Post-operative length of stay was predicted by age (P < 0.001) and emergency presentation (P = 0.003). CONCLUSION: In a multivariate regression model, intrathoracic stomach percentage was predictive of operative and post-operative morbidity, PPI use, and failure to improve reflux symptoms at 12 months. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/36278994/Percentage_of_intrathoracic_stomach_predicts_operative_and_post_operative_morbidity_persistent_reflux_and_PPI_requirement_following_laparoscopic_hiatus_hernia_repair_and_fundoplication_ DB - PRIME DP - Unbound Medicine ER -