Open AccessThe natural course of giant paraesophageal hernia and long‐term outcomes following conservative management
Author(s) -
Oude Nijhuis Renske A B,
Hoek Margot,
Schuitenmaker Jeroen M,
Schijven Marlies P,
Draaisma Werner A,
Smout Andreas J P M,
Bredenoord Albert J
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640620953754
Subject(s) - medicine , hernia , odds ratio , surgery , vomiting , abdominal pain , confidence interval , general surgery
Background Accurate information on the natural course of giant paraesophageal hernia is scarce, challenging therapeutic decisions whether or not to operate. Objective We aimed to investigate the long‐term outcomes, including hernia‐related deaths and complications (e.g. volvulus, gastrointestinal bleeding, strangulation) of patients with giant paraesophageal hernia that were conservatively managed, and to determine factors associated with clinical outcome. Methods We retrospectively analysed charts of patients diagnosed with giant paraesophageal hernia between January 1990 and August 2019, collected from a university hospital in The Netherlands. Included patients were subdivided into three groups based on primary therapeutic decision at diagnosis. Radiological, clinical and surgical characteristics, along with long‐term outcomes at most recent follow‐up, were collected. Results We included 293 patients (91 men, mean age 70.3 ± 12.4 years) with a mean duration of follow‐up of 64.0 ± 58.8 months. Of the 186 patients that were conservatively treated, a total hernia‐related mortality of 1.6% was observed. Hernia‐related complications, varying from uncomplicated volvulus to strangulation, occurred in 8.1% of patients. Only 1.1% of patients included in this study required emergency surgery. Logistic regression analysis revealed the presence of symptoms (odds ratio (OR) 4.4, 95% confidence interval (CI) 1.8–20.6), in particular obstructive symptoms (vomiting, OR 15.7, 95% CI 4.6–53.6; epigastric pain, OR 4.4, 95% CI 1.2–15.8 and chest pain, OR 6.1, 95% CI 1.8–20.6) to be associated with the occurrence of hernia‐related complications. Conclusions Hernia‐related death and morbidity is low in conservatively managed patients. The presence of obstructive symptoms was found to be associated with the occurrence of complications during follow‐up. Conservative therapy is an appropriate therapeutic strategy for asymptomatic patients.