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Collis gastroplasty may reduce hiatal hernia recurrence risk
PHILADELPHIA — A shortened esophagus was associated with an increased risk for hiatal hernia recurrence in patients who previously underwent pre-operative esophageal manometry and either open or laparoscopic primary hiatal hernia repair, according to results presented at the American College of Gastroenterology Annual Meeting.
The results also demonstrated that hiatal hernia recurrence risk decreased after a Collis gastroplasty was performed.
“Our study suggests that shortened esophagus is associated with higher hiatal hernia recurrence, while a lengthening procedure, such as a Collis gastroplasty, may reduce that risk,” Pooja Lal, MD, of the Cleveland Clinic, said during her presentation.
Lal and colleagues conducted a retrospective study of 267 patients who underwent pre-operative esophageal manometry and either open or laparoscopic primary hiatal hernia repair from 2005 to 2016 to assess the association of pre-operative esophageal length – which was adjusted for an individual’s height – and hiatal hernia recurrence after primary repair.
The researchers also aimed to evaluate the effect of Collis gastroplasty on hiatal hernia recurrence.
Collis gastroplasty was performed in 165 patients (median age at initial surgery, 63.4 years; 75.2% female) and a laparoscopic procedure was performed in 102 patients (median age at initial surgery, 55.9 years; 63.7% female).
On multivariate analysis, esophageal length/body height ratio (OR = 0.76; 95% CI, 0.61-0.95) was found to have an inverse relationship with hernia recurrence. Additionally, Collis gastroplasty decreased hernia recurrence (OR = 0.2; 95% CI, 0.05-0.86).
Ten percent of patients who underwent laparoscopic surgery had to undergo a second surgery compared with zero patients who underwent a Collis gastroplasty (P < .001).
“So, gastroenterologists and surgeons should consider the esophageal length to height ratio when planning the operative approach for hiatal hernia repair,” Lal said. “And, as gastroenterologists, we should send our patients with [a] short esophagus to surgeons who have the capability to perform a Collis procedure. We all know that pre-operative laparoscopic surgeries are favored more because of the shorter post-op hospital stay and the lower risk of complications, but our study suggests that for patients with short esophagus, Collis gastroplasty might actually be the right choice.”
Lal acknowledged that there were limitations to the results. Because the study was retrospective in nature, Lal said that there was no standardized post-operative follow-up protocol.
Additionally, there was not a standardized questionnaire to evaluate symptom recurrence.
However, Lal noted that further research is on the horizon.
“The next steps are going to be to perform a prospective study to eliminate these limitations and to also find out the clinical significance of these [current] findings,” she said. – by Ryan McDonald
Reference:
Lal P, et al. Abstract 28. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.
Disclosures: The researchers report no relevant financial disclosures.