Paraesophageal Hernia Clinical Trial
Official title:
Thirty-year Follow-up of a Case Series of Patients Operated Upon for Type II-IV Hiatal Hernia
Surgical therapy for gastroesophageal reflux disease (GERD) and hiatal hernia (HH) can
achieve outcomes that afford the patient lifelong satisfaction. The published results
obtained with this surgery may not be considered to be definitive in relation to the length
of follow-up or patients' life expectancy. The real recurrence rates and the results of
surgery for GERD are difficult to assess due to the lack of serial time points during the
follow-up. Further bias may have been introduced into the analysis by a lack of appropriate
controls. The results of surgical therapy for type II-IV HH are even more controversial
because of the high rate of anatomical relapse and the different methods of follow-up
adopted in reported case series.
Aim of this study is to clarify the value of surgical therapy for type II-IV HH. The
investigators report on patients who were followed up after surgery at various time points
over the course of 30 years.
We reviewed the charts of patients who underwent primary surgery for type II-IV Hiatal
Hernia during the period from January 1980 - December 2010.
Pre-operatively, the patients routinely underwent symptom assessment, a barium swallow,
upper GI endoscopy and esophageal manometry.
The principles of surgery for GERD and hiatal hernias involve full isolation of the
diaphragmatic pillars and E-G junction, full isolation and resection of the sac and fat pad
into the mediastinum (except for the fat close to the lesser curvature, to preserve the
integrity of the vagus nerves), evaluation of the degree of esophageal shortening, and a
Collis gastroplasty in cases of short esophagi.
Post-operatively, the patients participated in a free-of-charge outpatient follow-up program
at 6 months, 12 months and every year for 5 years.
The length of the follow-up was calculated from the day of the surgery to the day that the
patient underwent the last complete follow-up. The type and severity of symptoms and the
grade of reflux esophagitis were scored using a questionnaire with semi-quantitative scales
(from 0 = absence of symptoms and esophagitis to 3 = severe symptoms and esophagitis). An
evaluation scale for the surgical results, with scores ranging from "excellent" to "poor",
was also used.
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Observational Model: Cohort, Time Perspective: Retrospective
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