The University of Edinburgh Medical School, The University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
Department of Oesophago-Gastric Surgery, Royal Infirmary Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
Surg Endosc. 2019 Jun;33(6):1846-1853. doi: 10.1007/s00464-018-6463-y. Epub 2018 Nov 7.
There are limited data regarding long-term outcomes after surgical repair of giant paraoesophageal hiatus hernia (GPHH). The aim of this study was to assess symptomatic recurrence and patient-reported outcomes following GPHH repair.
178 patients undergoing elective (127) and emergency (51) GPHH repair between 1994 and 2015 were identified from the prospectively collected Lothian Surgical Audit database. Electronic patient records were used to determine rate of clinical recurrence. A postal questionnaire was used to assess modified DeMeester, 'Gastrointestinal Symptom Rating Scale' symptom scores, breathing and exercise tolerance, and patient satisfaction.
Median follow-up was 35 months (range 12-238). 15 (8.4%) patients developed a clinical recurrence and 13 (7.3%) underwent a further operation. The clinical recurrence rates were similar in patients followed-up less than 5 years and beyond 5 years [10/128 (7.8%) vs 5/50 (10%)]. Mortality rate was 1.6% for elective compared with 16.7% for emergency procedures (P < 0.001). Completed questionnaires were received from 95 (78.5%) of 121 eligible patients. Mean symptom scores were low (Modified DeMeester 2.6). 83.7% of patients reported a good or excellent outcome, and 97.8% believed they had made the correct decision to undergo surgery.
Surgical repair of GPHH is associated with high levels of patient satisfaction and good overall symptom outcome. There is a clinical recurrence rate of 8.4%, which does not significantly increase with long-term follow-up.
关于巨大食管裂孔疝（GPHH）手术后的长期结果，数据有限。本研究旨在评估 GPHH 修复后的症状复发和患者报告的结果。
从前瞻性收集的洛锡安手术审计数据库中确定了 1994 年至 2015 年间接受择期（127 例）和紧急（51 例）GPHH 修复的 178 例患者。使用电子病历记录确定临床复发率。通过邮寄问卷评估改良的 DeMeester、“胃肠道症状评分量表”症状评分、呼吸和运动耐量以及患者满意度。
中位随访时间为 35 个月（范围 12-238）。15 例（8.4%）患者发生临床复发，13 例（7.3%）患者接受进一步手术。随访不足 5 年和超过 5 年的患者临床复发率相似[10/128（7.8%）比 5/50（10%）]。择期手术的死亡率为 1.6%，而急诊手术为 16.7%（P<0.001）。从 121 名符合条件的患者中收到了 95 份（78.5%）完成的问卷。平均症状评分较低（改良 DeMeester 2.6）。83.7%的患者报告治疗效果良好或极好，97.8%的患者认为他们做出了接受手术的正确决定。
GPHH 的手术修复与高满意度和良好的整体症状结果相关。临床复发率为 8.4%，随长期随访无显著增加。
