Hernia Repair for Typical and Atypical GERD Improves Long-Term QOL Outcomes

Revision paraesophageal hernia repair can improve quality of life in patients with typical and atypical GERD.

Patients with atypical gastroesophageal reflux disease (GERD) demonstrated similar outcomes and improvements in quality of life (QOL) as those with typical GERD following revision laparoscopic antireflux surgery (RLAS), according to study findings published in Surgical Endoscopy.

Patients with atypical GERD symptoms often received treatment much later than those with typical GERD symptoms due to diagnostic delays. This study assessed the differences in QOL and perioperative outcomes following RLARS in patients with both typical and atypical GERD.

Researchers conducted a retrospective review of 133 patients who underwent RLAS between February 2003 and October 2019. They divided the patients into 2 groups based on reflux symptom presentation, with 61 patients in the typical reflux group and 72 in the atypical reflux group.

When analyzing various patient characteristics in each group, the investigators noted that patients in the typical reflux group presented with higher frequency of type 3 hiatal hernias (62.3% vs 29.2%) and Collis gastroplasty (29.5% vs 5.6%).

Further research is needed to determine universal diagnostic criteria to assist in the early detection and surgical treatment of patients with atypical GERD.

Following partial or complete fundoplication, both groups demonstrated similar hospital lengths of stay (typical: 3±3.4 days vs atypical: 2.4±1.7 days). Both groups shared similar patient characteristics, including body mass index, female sex, mean age around 55 to 58 years, and similar Charlson scores.

Patient outcome measures included the Reflux Symptom Index (RSI). Patients in both the typical and atypical groups reported improvements on the RSI after a mean follow-up time of 30.2±33.6 months (58.1% vs 43.3%, respectively; P =.149). At the last follow-up assessment, patients in the typical group demonstrated significantly higher RSI scores after the hernia revision surgery compared with the atypical group (2.8±5.3 vs 15.9±11.1, respectively).

“Patients who undergo revision paraesophageal hernia repair with objective findings of GERD and subjective complaints of atypical reflux symptoms may show long-term improvement in QOL outcomes,” the study authors wrote. “However, these results are contingent on proper patient selection and a thorough work-up for pathological reflux in this population. Further research is needed to determine universal diagnostic criteria to assist in the early detection and surgical treatment of patients with atypical GERD.”

Study limitations include the retrospective design, lack of generalizability to all surgical practices, lack of assessment of patient recommencement of using proton-pump inhibitors following surgery, and gradual loss of patients to follow-up over time.

References:

Addo AJ, Fatunmbi AM, Ramdeen SL, et al. Revision paraesophageal hernia repair outcomes in patients with typical and atypical reflux. Surg Endosc. Published online October 3, 2022. doi:10.1007/s00464-022-09635-7