Amprayil Mathew A, Ahmed Muktar, Irvine Tanya, Thompson Sarah K, Bright Tim, Watson David I
Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.
Surg Endosc. 2025 Jul;39(7):4376-4385. doi: 10.1007/s00464-025-11808-z. Epub 2025 May 29.
Obesity is a risk factor for the development of a large hiatus hernia. Such hernias are often symptomatic and negatively impact quality of life. However, surgeons can be reluctant to operate on obese patients due to concerns of operative complexity, early hernia recurrence, and increased morbidity. To evaluate this, we assessed the perioperative risks and short-term outcomes following surgery in obese and morbidly obese patients.
Patients who underwent repair of a large hiatus hernia (≥50% intrathoracic stomach) from January 2000 to December 2023 were identified from a prospective database. Patients were categorised based on body mass index (BMI) into 3 groups: non-obese (BMI < 30.0), obese (BMI 30.0-34.9), and morbidly obese (BMI ≥ 35.0). Perioperative and postoperative outcomes were compared.
915 patients were included (non-obese: 519 [56.7%], obese: 276 [30.1%], morbidly obese: 120 [13.1%]). Morbidly obese patients were younger (69.2 vs 65.8 vs 64 years, p < 0.001) and more likely to be female (60.9 vs 79.7 vs 83.9%, p < 0.001). There were no differences in conversion rates (0.8 vs 0.7 vs 1.7%, p = 0.592), operative time (106.4 vs 103.4 vs 113.6 min, p = 0.074), or length of stay (2.8 vs 2.48 vs 2.57 days, p = 0.063). We found no differences in major complication (4.0 vs 2.9 vs 1.7%, p = 0.435) or return to theatre rates (2.7 vs 1.1 vs 1.7%, p = 0.475). 90-day mortality rates were low for all groups (0.2 vs 0.4 vs 0%). Postoperative heartburn severity was lowest in non-obese patients (0.94 vs 1.86 vs 1.21, p = 0.010). There were no differences in postoperative regurgitation severity (1.02 vs 1.30 vs 1.74, p = 0.185) or overall satisfaction (8.74 vs 8.62 vs 8.91, p = 0.702).
Large hiatus hernia repair is safe and effective in obese and morbidly obese populations.
肥胖是巨大食管裂孔疝发生的一个危险因素。此类疝常伴有症状，对生活质量产生负面影响。然而，由于担心手术复杂性、早期疝复发及发病率增加，外科医生往往不愿为肥胖患者实施手术。为对此进行评估，我们对肥胖和病态肥胖患者术后的围手术期风险及短期预后进行了评估。
从一个前瞻性数据库中确定2000年1月至2023年12月期间接受巨大食管裂孔疝（胸腔内胃≥50%）修复术的患者。根据体重指数（BMI）将患者分为3组：非肥胖（BMI＜30.0）、肥胖（BMI 30.0 - 34.9）和病态肥胖（BMI≥35.0）。比较围手术期和术后结局。
共纳入915例患者（非肥胖：519例[56.7%]，肥胖：276例[30.1%]，病态肥胖：120例[13.1%]）。病态肥胖患者更年轻（69.2岁对65.8岁对64岁，p＜0.001），且女性比例更高（60.9%对79.7%对83.9%，p＜0.001）。中转率（0.8%对0.7%对1.7%，p = 0.592）、手术时间（106.4分钟对103.4分钟对113.6分钟，p = 0.074）或住院时间（2.8天对2.48天对2.57天，p = 0.063）无差异。我们发现主要并发症（4.0%对2.9%对1.7%，p = 0.435）或返回手术室率（2.7%对1.1%对1.7%，p = 0.475）无差异。所有组的90天死亡率均较低（0.2%对0.4%对0%）。非肥胖患者术后烧心严重程度最低（0.94对1.86对1.21，p = 0.010）。术后反流严重程度（1.02对1.30对1.74，p = 0.185）或总体满意度（8.74对8.62对8.91，p = 0.702）无差异。
巨大食管裂孔疝修复术在肥胖和病态肥胖人群中是安全有效的。
