Original article: general thoracicEffect of paraesophageal hernia repair on pulmonary function
Section snippets
Material and methods
The study included patients presenting with type II, III, and IV paraesophageal hernias to Virginia Mason Medical Center between 1995 and 2001. All patients were reviewed to document preoperative symptoms. Preoperative studies included chest roentgenogram (100%), barium swallow (100%), endoscopy (96%), manometry (89%), and 24-hour pH study (27%).
Basic spirometry studies and diffusion capacity measurements were carried out 1 to 4 weeks preoperatively and repeated 1 to 6 months following surgery.
Results
Patients were studied between 1995 and 2001. These included 45 patients, 16 males and 29 females, mean age 71.5 years (range 46 to 91). Presenting symptoms are shown in Table 1. Over 50% of patients presented with symptoms of gastroesophageal reflux disease, dysphagia, and regurgitation. However, 84% complained of some degree of dyspnea preoperatively. Two patients (5%) were on home oxygen preoperatively. Three patients underwent urgent operations following hospitalization for what was thought
Comment
There is a significant body of literature suggesting a relationship between pulmonary symptoms and gastroesophageal reflux disease 1, 2, 3. However, there is very little assessment of the potential ramifications of large hiatal hernias and pulmonary function.
Sliding (type I) hiatal hernias can become very large, but do not often reach the proportions seen with paraesophageal hernias (type II, III, and IV). Patients who present with these hernias are typically elderly and often present with
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A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair
2013, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :The majority of patients, particularly those with larger hernias, have mechanical symptoms such as pain, postprandial bloating, and bleeding (acute and occult). Careful assessment for symptoms frequently reveals symptoms of chest and abdominal pain, postprandial bloating, dysphagia, chronic anemia, weight loss, change in eating habits, or food avoidance.6,7,9 In patients with any of these symptoms, particularly when 75% or more of the stomach is herniated into the mediastinum, careful consideration for elective repair should be entertained.
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