Follow-up of Patients Operated Upon for Type II-IV Hiatal Hernia
Condition: Gastroesophageal Reflux Disease With Hiatal Hernia; Paraesophageal Hernia
MeSH terms: Gastroesophageal Reflux; Hernia; Hernia, Hiatal
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Surgical Therapy
Intervention type(s): Procedure
Intervention description(s): Open Anti-reflux fundoplication according to Nissen-Rossetti, floppy Nissen, Belsey MK IV,Collis Nissen, Collis-Belsey.
Minimally-Invasive fundoplication according to floppy Nissen, left thoracoscopic Collis-laparoscopic Nissen.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients consecutively operated upon for type II-IV hiatal hernia in the period January
        1980-December 2010.
      
Keywords: Gastroesophageal reflux diseases; Hiatal Hernia; Paraesophageal Hernia