Department of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
Department of Surgery, VA Puget Sound HCS, University of Washington, Seattle, WA, USA.
J Gastrointest Surg. 2023 Oct;27(10):2039-2044. doi: 10.1007/s11605-023-05754-1. Epub 2023 Jun 20.
In patients with paraesophageal hernias (PEH), the course of the esophagus is often altered, which may affect esophageal motility. High-resolution manometry (HRM) is frequently used to evaluate esophageal motor function prior to PEH repair. This study was performed to characterize esophageal motility disorders in patients with PEH as compared to sliding hiatal hernia and to determine how these findings affect operative decision-making.
Patients referred for HRM to a single institution from 2015 to 2019 were included in a prospectively maintained database. HRM studies were analyzed for the appearance of any esophageal motility disorder using the Chicago classification. PEH patients had confirmation of their diagnosis at the time of surgery, and the type of fundoplication performed was recorded. They were case-matched based on sex, age, and BMI to patients with sliding hiatal hernia who were referred for HRM in the same period.
There were 306 patients diagnosed with a PEH who underwent repair. When compared to case-matched sliding hiatal hernia patients, PEH patients had higher rates of ineffective esophageal motility (IEM) (p<.001) and lower rates of absent peristalsis (p=.048). Of those with ineffective motility (n=70), 41 (59%) had a partial or no fundoplication performed during PEH repair.
PEH patients had higher rates of IEM compared to controls, possibly due to a chronically distorted esophageal lumen. Offering the appropriate operation hinges on understanding the involved anatomy and esophageal function of each individual. HRM is important to obtain preoperatively for optimizing patient and procedure selection in PEH repair.
在食管裂孔旁疝（PEH）患者中，食管的走行常常发生改变，这可能会影响食管动力。高分辨率测压（HRM）常用于 PEH 修补术前评估食管动力功能。本研究旨在比较 PEH 患者与滑动型食管裂孔疝患者的食管动力障碍特征，并确定这些发现如何影响手术决策。
本研究纳入了 2015 年至 2019 年期间在一家机构进行 HRM 检查的患者。使用芝加哥分类标准分析 HRM 研究中任何食管动力障碍的表现。PEH 患者在手术时确诊，并记录所行胃底折叠术的类型。根据性别、年龄和 BMI 与同期接受 HRM 检查的滑动型食管裂孔疝患者进行病例匹配。
共有 306 例 PEH 患者接受了修补术。与病例匹配的滑动型食管裂孔疝患者相比，PEH 患者无效食管动力（IEM）的发生率更高（p<.001），无蠕动的发生率更低（p=.048）。在无效动力的患者中（n=70），41 例（59%）在 PEH 修补术中行部分或无胃底折叠术。
与对照组相比，PEH 患者的 IEM 发生率更高，这可能是由于食管腔长期扭曲所致。选择合适的手术取决于对每位患者的相关解剖结构和食管功能的理解。HRM 对术前获得并优化 PEH 修补术患者和手术选择非常重要。
