Medium-Term results and quality of life after laparoscopic treatment of paraesophageal hiatus hernia

Introduction: Laparoscopic repair of paraesophageal and mixed hernias is feasible, with excellent immediate- and short-term results. However, recurrence rates of up to 40% have been observed in the medium- term. The use of quality of life scales allows the impact of surgical treatment on patients' global health status to be evaluated with greater precision but no information is available on quality of life after laparoscopic surgery for paraesophageal hernias or their recurrence. Objective: To prospectively evaluate anatomical/and or symptomatic recurrences and their correlation with quality of life in patients who underwent surgery for paraesophageal or mixed hernias. Material and method: All patients who underwent laparoscopic repair of paraesophageal or mixed hernias between February 1998 and March 2003 were reevaluated. All patients underwent an esophagogram. The patients' symptoms were analyzed and all patients were interviewed with administration of several quality of life tests: Short Form-36 (SF-36), Glasgow Dyspepsia Severity Score (GDSS) and Gastrointestinal Quality of Life Score (GIQLI). Results: During the study period, 46 patients underwent surgery. The mean age was 68 years (22-81). A minimum follow-up of 6 months was possible in 37 patients. Eight patients (8/37; 21%) reported postoperative gastrointestinal symptoms. Esophagogram was performed in 30 patients (30/37; 81%) and showed recurrence in six (20%). The quality of life scales, SF-37 and GDSS showed no significant differences with standard values for the Spanish population with similar age and comorbidity. Values of the GIQLI in patients without recurrence were similar to those in the general population. Patients with clinical recurrence showed significantly lower values than the group without recurrence and the group with radiological recurrence only. Conclusion: Laparoscopic treatment of paraesophageal and mixed hernias is feasible and safe and provides good quality of life in the medium term. However, the incidence of anatomical and functional recurrence is high. Consequently, the subgroup of patients at risk for treatment failure should be identified and alternative techniques to guarantee the durability of surgical repair should be provided. © 2004 Asociación Española de Cirujanos.