Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS4. Outcomes After Laparoscopic Giant Paraesophageal Hernia Repairin 636 PatientsJames D. Luketich, * Katie S. Nason, Rodney J. Landreneau, * Samuel Keeley,Omar Awais, Manisha Shende, Matthew J. Schuchert, Ghulam Abbas,Blair A. Jobe, Arjun PennathurThe Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh MedicalCenter, Pittsburgh, PA, USAInvited Discussant: Antoon LerutOBJECTIVE: Over the past decade, laparoscopic repair of giant paraesophagealhernias (LRGPEH) has been described but has a high rate of radiographic and/orsymptomatic recurrence in some centers. Our objective was to evaluate our resultswith LRGPEH.METHODS: A retrospective review of patients undergoing elective LRGPEH(1997–2008) was performed. Clinical outcomes, barium swallow (BaSwa) andquality-of-life (QoL) were assessed.RESULTS: LRGPEH was performed in 636 patients (median age 71; range 19–92).The median percent of intrathoracic stomach by BaSwa was 66% (range 30–100%).Hernia reduction, sac resection, crural repair (mesh-reinforcement in 13% (84/636)and fundoplication was performed in 98% (407/636) with Collis-gastroplasty in63% (407/636). Open conversion rate was 1.4% (9/636). Nine patients (9/636;1.4%) required re-operation for leaks. Median length of stay (LOS) was 3 days(range 1–63). Pleural effusion (54/636; 9%) and pneumonia (27/636; 4%) were themost common major complications. Mortality was 2% at 30-days (11/636). PostoperativeGERD-Health-related QoL scores (30-month median clinical follow-up)were available for 470 patients with “Good” to “Excellent” results in 91% (428/470)of patients (excellent = 0–5; good = 6–10). Recurrence requiring re-operationoccurred in 2.5% (16/636). Overall, surgical result was satisfactory in 92% (432/470).CONCLUSION: In the largest series to date, LRGPEH was performed in 636patients with a 1.4% open conversion rate, a 3 day LOS, and 30-day mortality rateof 2%. At 30 months median clinical follow-up, 92% of patients were satisfied withthe surgical result. Re-operation for recurrence was required in 2.5%, which iscomparable to open series.* AATS Member74