The natural course of giant paraesophageal hernia and long-term outcomes following conservative management

Renske A. B. Oude Nijhuis, Margot van der Hoek, Jeroen M. Schuitenmaker, Marlies P. Schijven, Werner A. Draaisma, Andreas J. PM Smout, Albert J. Bredenoord

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Accurate information on the natural course of giant paraesophageal hernia is scarce, challenging therapeutic decisions whether or not to operate. Objective: We aimed to investigate the long-term outcomes, including hernia-related deaths and complications (e.g. volvulus, gastrointestinal bleeding, strangulation) of patients with giant paraesophageal hernia that were conservatively managed, and to determine factors associated with clinical outcome. Methods: We retrospectively analysed charts of patients diagnosed with giant paraesophageal hernia between January 1990 and August 2019, collected from a university hospital in The Netherlands. Included patients were subdivided into three groups based on primary therapeutic decision at diagnosis. Radiological, clinical and surgical characteristics, along with long-term outcomes at most recent follow-up, were collected. Results: We included 293 patients (91 men, mean age 70.3 ± 12.4 years) with a mean duration of follow-up of 64.0 ± 58.8 months. Of the 186 patients that were conservatively treated, a total hernia-related mortality of 1.6% was observed. Hernia-related complications, varying from uncomplicated volvulus to strangulation, occurred in 8.1% of patients. Only 1.1% of patients included in this study required emergency surgery. Logistic regression analysis revealed the presence of symptoms (odds ratio (OR) 4.4, 95% confidence interval (CI) 1.8–20.6), in particular obstructive symptoms (vomiting, OR 15.7, 95% CI 4.6–53.6; epigastric pain, OR 4.4, 95% CI 1.2–15.8 and chest pain, OR 6.1, 95% CI 1.8–20.6) to be associated with the occurrence of hernia-related complications. Conclusions: Hernia-related death and morbidity is low in conservatively managed patients. The presence of obstructive symptoms was found to be associated with the occurrence of complications during follow-up. Conservative therapy is an appropriate therapeutic strategy for asymptomatic patients.
Original languageEnglish
Pages (from-to)1163-1173
Number of pages11
JournalUnited European gastroenterology journal
Volume8
Issue number10
Early online date2020
DOIs
Publication statusPublished - Dec 2020

Keywords

  • Paraesophageal hernia
  • acute symptoms
  • complication
  • conservative therapy
  • hiatal hernia
  • intrathoracic stomach
  • watchful waiting

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