Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive MC 0740, La Jolla, San Diego, CA, 92093-0740, USA.
Surg Endosc. 2020 May;34(5):2243-2247. doi: 10.1007/s00464-019-07014-3. Epub 2019 Jul 25.
Chronic anemia is a common, coinciding or presenting diagnosis in patients with paraesophageal hernia (PEH). Presence of endoscopically identified ulcerations frequently prompts surgical consultation in the otherwise asymptomatic patient with anemia. Rates of anemia resolution following paraesophageal hernia repair (PEHR) often exceed the prevalence of such lesions in the study population. A defined algorithm remains elusive. This study aims to characterize resolution of anemia after PEHR with respect to endoscopic diagnosis.
Retrospective review of a prospectively maintained database of patients with PEH and anemia undergoing PEHR from 2007 to 2018 was performed. Anemia was determined by preoperative labs: Hgb < 12 mg/dl in females, Hgb < 13 mg/dl in males, or patients with ongoing iron supplementation. Improvement of post-operative anemia was assessed by post-operative hemoglobin values and continued necessity of iron supplementation.
Among 56 identified patients, 45 were female (80.4%). Forty patients (71.4%) were anemic by hemoglobin value, 16 patients (28.6%) required iron supplementation. Mean age was 65.1 years, with mean BMI of 27.7 kg/m. One case was a Type IV PEH and the rest Type III. 32 (64.0%) had potential source of anemia: 16 (32.0%) Cameron lesions, 6 (12.0%) gastric ulcers, 12 (24.0%) gastritis. 10 (20.0%) had esophagitis and 4 (8%) Barrett's esophagus. 18 (36%) PEH patients had normal preoperative EGD. Median follow-up was 160 days. Anemia resolution occurred in 46.4% of patients. Of the 16 patients with pre-procedure Cameron lesions, 10 (63%) had resolution of anemia. Patients with esophagitis did not achieve resolution. 72.2% (13/18) of patients with no lesions on EGD had anemia resolution (p = 0.03).
Patients with PEH and identifiable ulcerations showed 50% resolution of anemia after hernia repair. Patients without identifiable lesions on endoscopy demonstrated statistically significant resolution of anemia in 72.2% of cases. Anemia associated with PEH adds an indication for surgical repair with curative intent.
慢性贫血是食管裂孔疝（PEH）患者常见的并存、并发或首发诊断。对于无明显症状但内镜发现溃疡的患者，通常会促使其进行外科会诊。PEH 修复（PEHR）后贫血的缓解率往往高于研究人群中此类病变的发生率。目前仍缺乏明确的治疗方法。本研究旨在根据内镜诊断分析 PEHR 后贫血的缓解情况。
回顾性分析了 2007 年至 2018 年间接受 PEHR 的 PEH 合并贫血患者的前瞻性数据库。术前实验室检查确定贫血：女性 Hgb<12mg/dl，男性 Hgb<13mg/dl，或正在接受铁补充治疗的患者。通过术后血红蛋白值和持续铁补充的需要来评估术后贫血的改善情况。
在 56 名确诊患者中，45 名女性（80.4%）。40 名患者（71.4%）存在血红蛋白值相关贫血，16 名患者（28.6%）需要铁补充。平均年龄为 65.1 岁，平均 BMI 为 27.7kg/m。1 例为 IV 型食管裂孔疝，其余为 III 型。32 例（64.0%）有潜在的贫血原因：16 例（32.0%）Cameron 病变，6 例（12.0%）胃溃疡，12 例（24.0%）胃炎。10 例（20.0%）食管炎和 4 例（8%）Barrett 食管。18 例（36%）PEH 患者术前 EGD 正常。中位随访时间为 160 天。46.4%的患者贫血得到缓解。术前 Cameron 病变的 16 例患者中，10 例（63%）贫血得到缓解。食管炎患者贫血未得到缓解。18 例无内镜下病变的患者中，72.2%（13 例）贫血得到缓解（p=0.03）。
PEH 合并可识别溃疡的患者，疝修补术后贫血缓解率为 50%。内镜下无明显病变的患者，72.2%的病例贫血有统计学意义的缓解。PEH 相关贫血增加了具有治愈意图的手术修复的适应证。
