Surgical repair of POH ups QoL, confers low complication risk

Acute surgical repair of large para-oesophageal hernias (POH) can be safely performed, yielding low morbidity and mortality rates, and leads to improved quality of life (QoL) among patients, a recent study has found.

The study included 27 adult POH patients (mean age 70.9 years, 70.37 percent women) who underwent acute hernia repair between 2005 and 2015. Follow-up data was available for 17 patients. The main study outcome was QoL, assessed using the Gastro-Oesophageal-Reflux-Disease-(GORD)-health related QoL (GORD-HRQoL) questionnaire. Postoperative outcomes were also evaluated.

Over a mean postoperative follow-up of 3.4 years, the average GORD-HRQoL score was 7.6±7.94, with 82.4 percent of patients saying that they were satisfied with the procedure and its outcomes. GORD-HRQoL tended to be poorer in those who underwent acute repair with mesh.

Notably, such high satisfaction rates remained true despite prolonged hospital stay (mean, 6.5±3.3 days) and the need for intensive care. At follow-up, 11 were on regular acid suppression therapy. In terms of operative outcomes, a morbidity rate of 30 percent was reported, while none of the followed patients died.

“This study adds value to a void in the existing body of literature about acute POH repairs. Furthermore, acute repair of large POH can be performed with no mortality and low morbidity,” the researchers said.

Important limitations of the study include its small sample size, due in large part to the rarity of such a presentation, as well as the lack of validated QoL questionnaires specific for mechanical symptoms, pushing the researchers to use GORD-HRQoL instead.