Objective: To evaluate complete tumor resection rate (primary objective), 30-day postoperative outcomes, and survival (secondary objectives) in patients with a hiatal hernia (HH) ≥5 cm (HH group) compared with those who did not have a HH or presented with a HH <5 cm (control group).
Background: HH is a risk factor for esophageal and junctional adenocarcinoma (EGJA). Its impact on the outcomes after EGJA surgery is unknown.
Methods: Among 367 patients who underwent surgery for EGJA, a HH was searched for on computerized tomography scan and barium swallow, with comparison between the HH (n = 42) and control (n = 325) groups.
Results: In the HH group, EGJAs exhibited higher rates of incomplete resection (50.0% vs 4.0%; P < 0.001), of pN3 stages (28.5% vs 10.1%; P = 0.002), and lower median survival (20.9 vs 41.0 mos; P = 0.001). After adjustment, a HH ≥5 cm was a predictor of incomplete resection (odds ratio 21.0, 95% confidence interval 9.4-46.8, P < 0.001) and a poor prognostic factor (hazard ratio 1.6, 95% confidence interval 1.1-2.5, P = 0.025). In the HH group, 30-day mortality was significantly higher in patients who received neoadjuvant radiotherapy (20.0% vs 0%; P = 0.040), which was related to greater cardiac and pulmonary toxicity.
Conclusions: For the first time, we showed that a HH ≥5 cm is associated with a poor prognosis in patients who had surgery for EGJA, linked to greater incomplete resection and lymph node involvement. Neoadjuvant radiotherapy was associated with a significant toxicity in patients with a HH ≥5 cm.
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http://dx.doi.org/10.1097/SLA.0000000000001769 | DOI Listing |
J Am Coll Surg
January 2025
Prisma Health Upstate Department of Surgery, Greenville, SC.
Background: The concomitant hiatal hernia repair with endoscopic fundoplication (c-TIF) is a novel anti-reflux procedure that addresses the hiatus and the gastro-esophageal flap valve for surgical candidates with GERD. We aim to compare the outcomes of a hiatal hernia repair with endoscopic fundoplication (TIF) vs surgical partial fundoplication (anterior and posterior) with regards to quality-of-life scores at 12 months after surgery.
Study Design: Following IRB approval, a prospectively maintained anti-reflux database was retrospectively reviewed to identify patients who underwent a c-TIF procedure or a surgical hiatal hernia repair with partial fundoplication.
BMC Surg
January 2025
Center for Obesity and Hernia Surgery, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Background: The management of a recurrent (symptomatic) hiatal hernia remains controversial. This study aimed to review the outcomes of patients who underwent recurrent repair of hiatal hernias.
Methods: Thirteen patients who underwent recurrent hiatal hernia repairs at our hospital between 2018 and 2024 were reviewed retrospectively.
Int J Surg Case Rep
January 2025
Department of Public Health and Infectious Diseases, Faculty of Medicine, Herat University, Herat, Afghanistan; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Introduction: This case report presents a rare occurrence of Type III Congenital Paraesophageal Hiatal Hernia (CPEHH) with Infantile Hypertrophic Pyloric Stenosis (IHPS) in a 28-day-old neonate. However, this unusual combination poses significant diagnostic and surgical challenges.
Presentation Of Case: A 28-day-old male presented with respiratory distress and persistent vomiting.
Dis Esophagus
January 2025
Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CAUSA.
Data on Barrett's esophagus (BE) and esophageal cancer (EC) outcomes in patients with eosinophilic esophagitis (EoE) are limited. We aimed to determine the risk of prevalent BE (<1 year after endoscopy), incident BE (≥1 year after endoscopy), and incident EC in patients with versus without EoE, and to identify predictors of BE/EC in EoE patients. We identified adult patients in the Merative MarketScan Database who underwent first-time upper endoscopy between 2008 and 2020.
View Article and Find Full Text PDFSurg Endosc
January 2025
Faculty of Medicine, Pediatric Surgery, Tanta University Hospital, Tanta, 31527, Egypt.
Background: Surgical fundoplication remains integral in managing gastroesophageal reflux disease (GERD) by addressing gastroesophageal valve incompetence. This study introduces a novel hybrid approach, the Eversion Cruroplasty and Collar Overwrap (ECCO) procedure, aiming to combine benefits of conventional partial wrapping and posteromedial cardiopexy, considering gastric fundus anatomical peculiarities as an anti-reflux barrier.
Methods: A retrospective analysis of pediatric patients presenting with refractory GERD from 2021 to 2023 was conducted.
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