Nationwide Survey of the Surgical Treatment for Hiatal Hernia in Japan.

AIM: This study aimed to clarify patient background characteristics, preoperative findings, surgical factors, and postoperative outcomes according to hernia type in patients who underwent surgery for hiatal hernia in Japan.

METHODS

We conducted a retrospective, questionnaire-based clinical review of patients who underwent surgery between January 2001 and December 2015 at institutions with board-certified esophagologists accredited by the Japan Esophageal Society. Data from 960 cases across 80 institutions in Japan were analyzed.

RESULTS

Of the 960 cases, data on hernia type were available in 838 and included in the analysis. The distribution was as follows: Type I, 524 cases (63%); Type II, 53 (6%); Type III, 171 (20%); and Type IV, 90 (11%). Compared with Types II-IV, Type I patients were younger, more often male, had longer symptom duration, more heartburn, fewer comorbidities, and more severe esophagitis. Strictures were rare, and surgery was more often indicated due to refractoriness to medical treatment. Type I cases had higher rates of laparoscopic surgery and Toupet fundoplication, with shorter operative times, fewer complications, and shorter hospital stays. They had lower rates of postoperative dysphagia. Risk factors for postoperative dysphagia included Types II-IV hernia (OR 1.676, p = 0.002), preoperative dysphagia (OR 1.898, p = 0.006), and esophageal strictures (OR 3.102, p = 0.016). Hernia type was not associated with postoperative recurrence.

CONCLUSION

Patients with Type I hernia differed from those with Types II-IV in background characteristics, preoperative findings, surgical factors, and postoperative outcomes. Given the higher risk of postoperative dysphagia in Types II-IV, careful attention to surgical technique is warranted.