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The Other Explanation for Dyspnea: Repair of Giant Paraesophageal Hiatal Hernias Routinely Improves Dyspnea and Pulmonary Function Results
Description
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A7511 - The Other Explanation for Dyspnea: Repair of Giant Paraesophageal Hiatal Hernias Routinely Improves Dyspnea and Pulmonary Function Results
Author Block: S. H. Kirtland1, A. Wirsching2, D. Low3; 1Pulmonary, Virginia Mason Medical Center, Seattle, WA, United States, 2General, Vascular and Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, United States, 3Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, United States.
Background
Paraesophageal hiatal hernias present with a variety of symptoms. These patients will often present with an evolving history of dyspnea. The dyspnea is often unrelated to pre-existing pulmonary disease. Surgical repair of the paraesophageal hernia typically improves the dyspnea along with other gastrointestinal symptoms.
Methods
A prospective IRB approved database was used to retrospectively review all patients undergoing PEH repair between 2000-2016. Patients (N = 299) with pre- and postoperative pulmonary function tests (PFTs) assessed by spirometry were included in the analysis. Demographics, presenting symptoms, pre-existing pulmonary co-morbidities, spirometry and functional outcomes were assessed in patients defined as being ""high achievers"" (improvement of FEV1 > 12% after surgery) and compared to the remainder of the patient population.
Results
49% of patients reported preoperative shortness of breath and symptomatic improvement was noted in all patients. 122 of 299 (41%) patients had an FEV1 improvement of > 12%. Patients presenting with moderate and severe pulmonary obstruction demonstrated > 12% improvement in FEV1 in 48% and 40%, respectively. Age, gender, BMI, presenting symptoms, Charlson comorbidity index as well as
preoperative comorbidities such as asthma, obstructive sleep apnea, smoking history and COPD did not significantly impact functional outcome. Achieving FEV1 improvement of > 12% was associated with hiatal hernias characterized by a percentage of intrathoracic stomach ≥ 76% (p=0.001). Overall, 80% of patients demonstrated an improvement of spirometry with 21% of patients showing an improvement in FEV1 > 20%. Mean improvement of FVC, FEV1, VC were 11% each. Mean improvement of DLCO was 5%.
Conclusion
Paraesophageal hernia repair can result in a substantial improvement to dyspnea and PFTs independent of preoperative pulmonary disease status. Patients with dyspnea and paraesophageal hiatal hernias should be considered for elective repair.
Author Block: S. H. Kirtland1, A. Wirsching2, D. Low3; 1Pulmonary, Virginia Mason Medical Center, Seattle, WA, United States, 2General, Vascular and Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, United States, 3Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, United States.
Background
Paraesophageal hiatal hernias present with a variety of symptoms. These patients will often present with an evolving history of dyspnea. The dyspnea is often unrelated to pre-existing pulmonary disease. Surgical repair of the paraesophageal hernia typically improves the dyspnea along with other gastrointestinal symptoms.
Methods
A prospective IRB approved database was used to retrospectively review all patients undergoing PEH repair between 2000-2016. Patients (N = 299) with pre- and postoperative pulmonary function tests (PFTs) assessed by spirometry were included in the analysis. Demographics, presenting symptoms, pre-existing pulmonary co-morbidities, spirometry and functional outcomes were assessed in patients defined as being ""high achievers"" (improvement of FEV1 > 12% after surgery) and compared to the remainder of the patient population.
Results
49% of patients reported preoperative shortness of breath and symptomatic improvement was noted in all patients. 122 of 299 (41%) patients had an FEV1 improvement of > 12%. Patients presenting with moderate and severe pulmonary obstruction demonstrated > 12% improvement in FEV1 in 48% and 40%, respectively. Age, gender, BMI, presenting symptoms, Charlson comorbidity index as well as
preoperative comorbidities such as asthma, obstructive sleep apnea, smoking history and COPD did not significantly impact functional outcome. Achieving FEV1 improvement of > 12% was associated with hiatal hernias characterized by a percentage of intrathoracic stomach ≥ 76% (p=0.001). Overall, 80% of patients demonstrated an improvement of spirometry with 21% of patients showing an improvement in FEV1 > 20%. Mean improvement of FVC, FEV1, VC were 11% each. Mean improvement of DLCO was 5%.
Conclusion
Paraesophageal hernia repair can result in a substantial improvement to dyspnea and PFTs independent of preoperative pulmonary disease status. Patients with dyspnea and paraesophageal hiatal hernias should be considered for elective repair.
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