Asian journal of endoscopic surgery · 2025
Quality of Life Following Laparoscopic Hiatal Hernia Repair and Anterior 180° Partial Fundoplication for Symptomatic Sliding Hiatal Hernia.
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Siow Sze Li, Ong Ernest Cun Wang
Аннотация
BACKGROUND: Laparoscopic hiatal hernia repair (LHHR) is the treatment of choice for symptomatic sliding hiatal hernia. This study evaluates health-related quality of life (HRQOL) outcomes following LHHR with anterior 180° partial fundoplication.
METHODS: Forty consecutive patients underwent LHHR with anterior 180° partial fundoplication between June 2020 and December 2022. Patients were included based on one of the following criteria: persistent symptoms despite optimal medical therapy (55%), preference for a surgical solution over lifelong medication (37.5%), or complications including reflux oesophagitis/Barrett's esophagus (7.5%). HRQOL was assessed using the SF-36 questionnaire preoperatively and at 1, 6, and 12 months postoperatively.
RESULTS: Significant improvements were observed in physical functioning (66.3 ± 24.7 to 95.6 ± 7.7, p < 0.001), bodily pain (38.1 ± 28.1 to 79.2 ± 18.6, p < 0.001), general health (37.7 ± 16.2 to 66.1 ± 23.6, p < 0.001), social function (62.5 ± 23.7 to 85.6 ± 16.1, p < 0.001), and mental health (68.2 ± 21.4 to 83.7 ± 12.5, p < 0.001) at 12 months. Role limitations due to physical health improved gradually, becoming significant at 12 months (60.0 ± 45.6 to 86.9 ± 16.8, p < 0.001). Early improvements in vitality (p = 0.02) and role limitations due to emotional health (p = 0.331) showed some decline by 12 months. The median hospital stay was 3 days, with no major complications. At 1 year, 72.5% of patients were medication-free, while anatomical recurrence was observed in 7.5%. Patients with recurrence showed lower physical functioning (82.3 vs. 96.8, p = 0.02) and bodily pain scores (65.7 vs. 80.5, p = 0.04) but still demonstrated significant improvement from baseline. Body mass index, education level, age, and defect area did not influence outcomes (all p > 0.05).
CONCLUSION: LHHR with anterior 180° partial fundoplication significantly improves quality of life across multiple domains, with sustained benefits at 12 months post-surgery, particularly in physical function, pain, and social functioning. Most domains reached or surpassed population norms by 12 months, establishing this approach as an effective treatment for symptomatic sliding hiatal hernia.
METHODS: Forty consecutive patients underwent LHHR with anterior 180° partial fundoplication between June 2020 and December 2022. Patients were included based on one of the following criteria: persistent symptoms despite optimal medical therapy (55%), preference for a surgical solution over lifelong medication (37.5%), or complications including reflux oesophagitis/Barrett's esophagus (7.5%). HRQOL was assessed using the SF-36 questionnaire preoperatively and at 1, 6, and 12 months postoperatively.
RESULTS: Significant improvements were observed in physical functioning (66.3 ± 24.7 to 95.6 ± 7.7, p < 0.001), bodily pain (38.1 ± 28.1 to 79.2 ± 18.6, p < 0.001), general health (37.7 ± 16.2 to 66.1 ± 23.6, p < 0.001), social function (62.5 ± 23.7 to 85.6 ± 16.1, p < 0.001), and mental health (68.2 ± 21.4 to 83.7 ± 12.5, p < 0.001) at 12 months. Role limitations due to physical health improved gradually, becoming significant at 12 months (60.0 ± 45.6 to 86.9 ± 16.8, p < 0.001). Early improvements in vitality (p = 0.02) and role limitations due to emotional health (p = 0.331) showed some decline by 12 months. The median hospital stay was 3 days, with no major complications. At 1 year, 72.5% of patients were medication-free, while anatomical recurrence was observed in 7.5%. Patients with recurrence showed lower physical functioning (82.3 vs. 96.8, p = 0.02) and bodily pain scores (65.7 vs. 80.5, p = 0.04) but still demonstrated significant improvement from baseline. Body mass index, education level, age, and defect area did not influence outcomes (all p > 0.05).
CONCLUSION: LHHR with anterior 180° partial fundoplication significantly improves quality of life across multiple domains, with sustained benefits at 12 months post-surgery, particularly in physical function, pain, and social functioning. Most domains reached or surpassed population norms by 12 months, establishing this approach as an effective treatment for symptomatic sliding hiatal hernia.