Quality of life and long-term results of reinterventions performed by laparoscopy after oesophageal hiatus surgery

Ortiz, Inmaculada; Targarona, Eduard M.; Pallares, Lluís; Marinello, Franco; Balagué, Carmen; Trías, Manuel

doi:10.1016/S2173-5077(09)70073-0

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Abstract

Introduction

Laparoscopic surgery has had a significant impact on gastro-oesophageal reflux disease (GORD), para-oesophageal hiatal hernia (POHH), and achalasia. There have been a percentage of poor results due to reappearance, persistence or appearance of new symptoms. Reinterventions of the hiatus are more complicated and are not always accompanied by a satisfactory clinical response.

Objective To evaluate the long-term results of a series of 20 patients reintervened by laparoscopy and their quality of life.

Material and methods

A total of 20 patients operated on between February 1998 and December 2008 after previous surgery for the hiatus. The mean age of the patients was 56 (19–77) years. A total of 18 patients had been operated on due to GORD or POHH and 2 due to achalasia. They were followed up until December 2008 and a quality of life GIQLI test was performed.

Results

Of the 20 patients, 13 were operated on by laparoscopy and 7 by laparotomy. The mean pre-operative time was 74 (1–24) months. The reintervention was for GORD and HH in 12 (63%); dysphagia in 4 (21%); and POHH (3). Conversion was 10% and the operating time was 180 (105–300) min. The procedures were: pillar closure and re-Nissen (10), re-Nissen (2), Toupet (2), Collis (1), mesh removal (1), re-myotomy (2), and pexy (1). There was 16% morbidity and no mortality. After a follow up of 68 (1–116) months, 14 patients were symptom-free. The GIQLI score was 106 (97–124), which was less than standard (125).

Conclusions

Reintervention of hiatus is reliable and effective over the long-term, but quality of life scores were lower than normal.

Keywords:

Reintervention

Oesophageal hiatus

Reflux disease

Hiatal hernia

Para-oesophageal hiatal hernia

Achalasia

Resumen

Introducción

La cirugía laparoscópica ha tenido un importante impacto en el tratamiento de la enfermedad por reflujo gastroesofágico (ERGE), la hernia de hiato paraesofágica (HHPE) y la acalasia. Se acompaña de un porcentaje de malos resultados por reaparición, persistencia o aparición de nueva sintomatología. Las reintervenciones sobre el hiato son más complejas y no siempre se acompañan de respuesta clínica satisfactoria.

Objetivo

Resultados a largo plazo de una serie de 20 pacientes reintervenidos por laparoscopia y evaluar su calidad de vida.

Material y métodos

Se intervino a 20 pacientes entre febrero de 1998 y diciembre de 2008 tras cirugía previa del hiato, con una media de edad de 56 (intervalo, 19–77) años; 18 pacientes habían sido operados por ERGE o HHPE y 2, por acalasia. Fueron seguidos hasta diciembre de 2008 y se pasó el test de calidad de vida GIQLI.

Resultados

13 pacientes habían sido operados por laparoscopia y 7, por laparotomía. La media de tiempo preoperatorio fue 74 (1–24) meses. La reintervención fue: en 12 (63%) por ERGE y hernia de hiato, 4 (21%) por disfagia y 3 por HHPE. La conversión fue del 10% y el tiempo operatorio, 180 (105–300) min. Los procedimientos fueron: cierre de pilares y re-Nissen (10), re-Nissen (2), Toupet (2), Collis (1), extirpación de malla (1), remiotomía (2) y pexia (1). La morbilidad fue del 16% y no hubo mortalidad. Tras seguimiento de 68 (1–116) meses, 14 pacientes están libres de síntomas. El valor de GIQLI fue 106 (97–124), menor que el estándar (125).

Conclusiones

La reintervención del hiato es factible y eficaz a largo plazo, sin lograr valores de calidad de vida semejantes a la normalidad.

Palabras clave:

Reintervención

Hiato esofágico

Enfermedad por reflujo

Hernia de hiato

Hernia de hiato paraesofágica

Acalasia

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