Esophagus

28 - Manometric Esophageal Length Predicts Hiatal Hernia Recurrence

Tuesday, October 9
8:30 AM - 8:40 AM
Location: Terrace Ballroom 2-3 (level 400)

Category: Esophagus
Pooja Lal, MD1, Shashank Sarvepalli, MD1, Andrew Tang, MD1, Siva Raja, MD, PhD2, Monica Ray, MD2, Sampurna Shakya1, Prasanthi N. Thota, MD3, Scott Gabbard, MD2
1Cleveland Clinic Foundation, Cleveland, OH; 2Cleveland Clinic, Cleveland, OH; 3Cleveland Clinic Digestive Disease Institute, Cleveland, OH

Introduction: Studies suggest that the selective treatment of short esophagus may reduce the recurrence rate of hiatal hernia after surgical repair. Despite this observation, there exists no data regarding the correlation of manometric esophageal length and rate of hernia recurrence. The objective of our study was to analyze the association of pre-operative manometric esophageal length (adjusted for body height) and hiatal hernia recurrence after primary repair.

Methods: From 2006-2015, 274 patients underwent pre-operative esophageal manometry and either open or laparoscopic primary hiatal hernia repair. Manometric esophageal length to body height ratio was calculated and then correlated to radiographic, endoscopic or manometric hiatal hernia recurrence. Other factors analyzed in relation to hernia recurrence included surgical approach, Collis gastroplasty and post-operative residual reflux symptoms. Differences in clinical and demographic characteristics were computed based on hernia recurrence. Chi square analysis was used to assess significance of difference between categorical variables. Mann-Whittney U test was used to assess differences between continuous variables. Multivariate logistic regression was performed to identify factors associated with Hernia recurrence. Using post-estimation function, probability of hernia recurrence was calculated based on the multivariate model.

Results: Of the 274 patients (71.2% were females mean age at the time of repair was 62.5), 68(24.8%) had hiatal hernia recurrence within the follow up period (mean length of follow up = 25 months 95% CI, 3.8, 58.8). On multivariate analysis, esophageal length/body height ratio (increment of 1%; OR 0.76;95% CI, 0.61, 0.95) was found to have an inverse relationship with hernia recurrence. Similarly, Collis gastroplasty decreased hernia recurrence (OR 0.2; 95% CI, 0.05, 0.86).

Discussion: These data suggest that shortened esophagus is associated with recurrence of hiatal hernia, while Collis gastroplasty may decrease the risk of recurrence.  Gastroenterologists and surgeons should consider esophageal length/body height when planning operative approach for hiatal hernia repair.

Multivariate logistic regression analysis of factors associated with recurrent hiatal hernia
Relationship between esophageal length (L)/body height (H) ratio (%) and adjusted probability of hernia recurrence based on the multivariate model

Disclosures:
Pooja Lal indicated no relevant financial relationships.
Shashank Sarvepalli indicated no relevant financial relationships.
Andrew Tang indicated no relevant financial relationships.
Siva Raja indicated no relevant financial relationships.
Monica Ray indicated no relevant financial relationships.
Sampurna Shakya indicated no relevant financial relationships.
Prasanthi Thota indicated no relevant financial relationships.
Scott Gabbard indicated no relevant financial relationships.

Pooja Lal

Cleveland Clinic Foundation
Cleveland, Ohio

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