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Prospective study of giant paraesophageal hernia repair with 1-year follow-up
Prospective observational cohort study of 106 patients undergoing repair of giant paraesphageal hernia (GPEH) with near complete follow-up at 1 year. Outcomes measured at the first postoperative visit and at one year were radiographic recurrence, patient satisfaction and GERD-HRQL score. Importantly, this study compared patients with small radiographic recurrence (<2cm) to those with a commonly used definition of radiographic recurrence (classified as large recurrence for this cohort): >2cm or 10% of the stomach above the diaphragm. Most patients underwent laparoscopic repair (80.2%) and 66% had an esophageal lengthening procedure. The overall recurrence rate at one year was 32.7% versus 18.8% using the commonly used definition (>2cm or 10% of the stomach above the diaphragm). Patient satisfaction increased from 2.9% preoperatively to 85% at 1 month and 71.4% at one year. There was no difference in patient satisfaction between those with small and large recurrences (57.1% versus 52.6%). The median GERD-HRQL score was 22.5 preoperative, 3.0 at one month, and 7.0 at one year. There was no difference in GERD-HRQL scores between patients with small and large recurrences (12.0 versus 14.0). The authors concluded that any recurrence, whether small or large, has a negative effect on patient satisfaction and control of symptoms and that there is a need for further investigation of patients with small recurrences to determine their clinical importance.