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REDO PEH REPAIR IS ASSOCIATED WITH EXCELLENT SYMPTOMATIC AND OBJECTIVE OUTCOMES
Stephanie G. Worrell, Kyle M. Green, Katrin Schwameis, Steven R. DeMeester.
Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.

OBJECTIVE: Recurrence after primary paraesophgeal hernia (PEH) repair is common. Each attempt to repair recurrent hernias at other sites such as the abdominal wall are associated with worse outcomes. The aim of this study was to evaluate the outcome with redo PEH repair.
METHODS: A retrospective chart review was performed of all patients that had a re-do PEH repair from 9/2009 to 7/2015.
RESULTS: There were 29 patients (16F:13M) that had a re-do repair for PEH recurrence. The median age was 60 years. The prior operation was performed a median of 97 months (range 3 days to 31 years) before the reoperation. The prior operation was done laparoscopically in 83% of patients and included a Nissen (n=19), partial (n=2) or unspecified fundoplication (n=8).
The indication for the reoperation was recurrence of symptoms (83%), persistent dysphagia (10%) and early recurrence of an intra-thoracic stomach (7%). All patients had objective evidence of a PEH. The reoperation was laparoscopic in 13 (45%) and open in 16 (55%). The laparoscopic procedure was converted to open in 4 patients. During the reoperation a Collis gastroplasty was added for esophageal shortening in 16 patients (55%) and 2 patients had diaphragmatic relaxing incisions to reduce crural tension. An absorbable mesh was placed to reinforce the crural closure in all patients. Median operative time was 171 minutes, EBL 150cc, and the median hospital stay was 6 days. There were 2 post-operative complications, a reintubation and post-operative atrial fibrillation. There were no mortalities. At a median follow-up of 10 months symptoms were resolved or improved in all patients. Objective follow-up was available from 79% of patients and there were no recurrent hernias.
CONCLUSIONS: Recurrence after PEH is common and some patients require reoperation. Re-do repair is more complicated and is more commonly done as an open procedure. During the reoperation 55% of patient had an adjunct procedure for esophageal shortening or crural tension. Early symptomatic and objective results are excellent, supporting the value of reoperation in appropriate patients.


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