Laparoscopic repair of large hiatal hernias: clinical outcomes of 10 years.

BACKGROUND: Whilst laparoscopic repair is the most common surgical procedure for the treatment of large hiatal hernias, knowledge of long-term outcomes (>10 years) is scarce. The aim of this study was to evaluate the long-term results following this approach, in particular the hernia recurrence rate and the impact of repair on quality of life (QoL).

METHODS: Patients were identified from a prospective database. A standardized questionnaire was used to assess symptoms and a barium swallow radiograph was performed to determine anatomy. A validated QoL measure, Gastrointestinal Quality of Life Index (GIQLI) was also applied to all patients.

RESULTS: Of the 69 eligible patients, clinical follow-up was available for 54 patients (78.3%). Follow-up ranged from 72 to 185 (median: 114) months. Post-operative heartburn and dysphagia were significantly improved, with 45 patients (83%) reporting a good or excellent result. Contrast radiology in 35 patients (65%) revealed recurrence in 12 patients (34%). Fifty-four patients answered the GIQLI questionnaire. The mean GIQLI score was 117 (61-136). Patients with objectively documented anatomic recurrence had a QoL index of 92 (61-121) compared to an index of 122 (77-136, P < 0.01) in the non-recurrent hernia group.

CONCLUSIONS: At mean 114 months follow-up, laparoscopic repair of large hiatal hernias achieves effective and durable relief of symptoms, and most patients are satisfied with the outcome.