Long-term surgical outcomes for the surgical management of complete intrathoracic stomach (CIS).

Abstract

<h4>Background & aims</h4>Surgery is indicated for symptomatic CIS patients to avoid complications (volvulus, obstruction and strangulation) associated with high morbidity and even mortality. There remains limited evidence of the long-term outcomes and improvement of symptoms from this procedure. Previous studies have been unable to compare preoperative symptoms with post-operative data. Although it appears the procedure has favourable outcomes, further data are required to demonstrate a significant improvement in quality of life (QoL). We therefore aim to assess the long-term outcomes, including changes to QoL and satisfaction, for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%).<h4>Methods</h4>Prospective data were collected from 154 consecutive GPEH (Giant Hiatus Hernia) patients intervened between March 2008 and March 2023 in a large DGH. Retrospective analysis of this identified 34 patients with CIS. All patients underwent a laparoscopic repair with mesh, apart from one patient who underwent conversion to open gastropexy. Outcome measures included both pre-operative and post-operative standardised GERD-Health-Related Quality of Life Questionnaire (GERD-QOL) scores; complications; and patient satisfaction.<h4>Results</h4>34 patients were included (11 male:23 female) with a mean age 72 (45-83) years. All patients were symptomatic pre-operatively with heartburn (59%), dysphagia (59%), retrosternal discomfort (53%), vomiting (41%), weight loss (41%) or shortness of breath (35%). There were 4 (12%) complications and 3 (9%) 30-day mortalities. Follow-up GERD-QOL questionnaires displayed 27/29 (93%) excellent scores (defined as total < 5) at 6 months and 15/21 (71%) excellent scores after a median follow up of 8.5 years. This demonstrated a significant improvement in long-term scores (p < 0.001).<h4>Conclusion</h4>Laparoscopic repair of complete intrathoracic stomach in this large single-centre study has demonstrated a significant improvement in symptoms and satisfaction over a median 8.5 years follow-up.