Anne-Sophie Laliberte, MD1, Jack Brandabur, MD2, Peter Baik, DO3, Anee Sophia Jackson, MD2, Adam J. Bograd, MD, BS2, Ralph W. Aye, MD2, Alexander Farivar, MD2, Brian E. Louie, MD, MHA, MPH2
1Swedish Medical Center, Quebec City, PQ, Canada; 2Swedish Medical Center, Seattle, WA; 3Cancer Treatment Centers of America, Tulsa, OK
Introduction: During iron deficiency anemia evaluation, patients may be found to have a paraesophageal hernia (PEH). Current GI guidelines recommend iron supplements and proton pump inhibitors (PPIs). Surgical repair is not recommended despite evidence of cure in the surgical literature, even in the absence of Cameron’s lesions. We examine the patterns of care of patients with pre-existing anemia who had PEH repair. We hypothesize that a more robust correction of anemia will be achieved in patients undergoing surgery.
Methods: We performed a retrospective chart review of consecutives patients with anemia and hiatal hernia that underwent a surgical repair between 2005-2016 in our system. Normal hemoglobin (Hgb) was defined for females as 12 g/dL and males 13 based on W.H.O. criteria and assessed at diagnosis, preoperatively and postoperatively.
Results: We analyzed 116 patients who were predominantly females with type 3 PEH of which 52.6% had Cameron ulcers. (Table 1)
After diagnosis, 24.1% were transfused, 52% started on iron supplements, 72% on PPIs and 10% on H2-blocker. Patients underwent 1.6 (IQR=1-5) EGDs, 1.1 (IQR=1-3) colonoscopies along with CT scans in 39% and capsule endoscopy in 16%. Median time from diagnosis to surgical referral was 381 days (IQR=129-1332).
All patients underwent laparoscopic hernia repair with a total fundoplication (90%), partial fundoplication (6%) or hernia repair only (4%). There were no mortalities. Only 16% experienced a morbidity with 5.6% being major.
The mean Hgb at diagnosis was 9.79 in females and 10.9 in males. It increased to 11.1 and 11.4 with medical management. With the addition of surgical repair, it increased to 12.3 and 13.4 at short term follow up. Thiswas sustained at 12.8 and 14.2 long term. (Figure 1)
The Hgb was normalized in only 36% of patients after medical management. Comparatively, the Hgb normalized after surgical repair in 62% at short term and in 74% at long term. Patients without Cameron’s ulcers normalized in 62%. (Table 2) After surgery, 95% ceased iron therapy and 73% were free from PPIs.
Discussion: Anemia associated with a PEH improves with medical therapy, but the addition of surgery normalizes Hgb and seems durable at 4 years without additional medical therapy. We recommend that surgical repair should be an integral part in the treatment, regardless of the presence of Cameron’s ulcers.
Citation: Anne-Sophie Laliberte, MD; Jack Brandabur, MD; Peter Baik, DO; Anee Sophia Jackson, MD; Adam J. Bograd, MD, BS; Ralph W. Aye, MD; Alexander Farivar, MD; Brian E. Louie, MD, MHA, MPH. P0257 - THE CRITICAL AND OFTEN DISREGARDED ROLE OF SURGERY IN CURING ANEMIA IN PATIENTS WITH HIATAL HERNIA. Program No. P0257. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.