Resolution and recurrence of anemia following repair of paraesophageal hernias.
Anemia
Fundoplication
Gastropexy
Paraesophageal hernia
Perioperative outcomes
Repair
Surgical techniques
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
05
05
2023
accepted:
12
07
2023
medline:
1
11
2023
pubmed:
1
8
2023
entrez:
31
7
2023
Statut:
ppublish
Résumé
Iron deficiency anemia is a common paraesophageal hernia (PEH) symptom and may improve after repair. When present, anemia has also been proposed to be associated with an increase in length of hospital stay, morbidity, and mortality after PEH repair. This study aimed to determine anemia-related factors in patients with PEH, the rate of anemia resolution after PEH repair, and the risk of anemia recurrence when repair failed. We included patients who received a PEH repair between June 2019 and June 2020 and had 24 months of postoperative follow-up. Demographics and comorbidities were recorded. Anemia was defined as pre-operative hemoglobin values < 12.0 for females and < 13.0 for males, or if patients were receiving iron supplementation. Anemia resolution was determined at 6 months post-op. Length of hospital stay, morbidity, and mortality was recorded. Logistic regression and ANCOVA were used for binary and continuous outcomes respectively. Of 394 patients who underwent PEH repair during the study period, 101 (25.6%) had anemia before surgery. Patients with pre-operative anemia had larger hernia sizes (6.55 cm ± 2.77 vs. 4.34 cm ± 2.50; p < 0.001). Of 68 patients with available data by 6 months after surgery, anemia resolved in 36 (52.9%). Hernia recurred in 6 patients (16.7%), 4 of whom also had anemia recurrence (66.7%). Preoperative anemia was associated with a higher length of hospital stay (3.31 days ± 0.54 vs 2.33 days ± 0.19 p = 0.046) and an increased risk of post-operative all-cause mortality (OR 2.7 CI 1.08-6.57 p = 0.05). Fundoplication type (p = 0.166), gastropexy, or mesh was not associated with an increased likelihood of resolution (OR 0.855 CI 0.326-2.243; p = 0.05) (OR 0.440 CI 0.150-1.287; p = 0.05). Anemia occurs in 1 out of 4 patients with PEH and is more frequent in patients with larger hernias. Anemia is associated with a longer hospital stay and all-cause mortality after surgery. Anemia recurrence coincided with hernia recurrence in roughly two-thirds of patients.
Sections du résumé
BACKGROUND
BACKGROUND
Iron deficiency anemia is a common paraesophageal hernia (PEH) symptom and may improve after repair. When present, anemia has also been proposed to be associated with an increase in length of hospital stay, morbidity, and mortality after PEH repair. This study aimed to determine anemia-related factors in patients with PEH, the rate of anemia resolution after PEH repair, and the risk of anemia recurrence when repair failed.
METHODS
METHODS
We included patients who received a PEH repair between June 2019 and June 2020 and had 24 months of postoperative follow-up. Demographics and comorbidities were recorded. Anemia was defined as pre-operative hemoglobin values < 12.0 for females and < 13.0 for males, or if patients were receiving iron supplementation. Anemia resolution was determined at 6 months post-op. Length of hospital stay, morbidity, and mortality was recorded. Logistic regression and ANCOVA were used for binary and continuous outcomes respectively.
RESULTS
RESULTS
Of 394 patients who underwent PEH repair during the study period, 101 (25.6%) had anemia before surgery. Patients with pre-operative anemia had larger hernia sizes (6.55 cm ± 2.77 vs. 4.34 cm ± 2.50; p < 0.001). Of 68 patients with available data by 6 months after surgery, anemia resolved in 36 (52.9%). Hernia recurred in 6 patients (16.7%), 4 of whom also had anemia recurrence (66.7%). Preoperative anemia was associated with a higher length of hospital stay (3.31 days ± 0.54 vs 2.33 days ± 0.19 p = 0.046) and an increased risk of post-operative all-cause mortality (OR 2.7 CI 1.08-6.57 p = 0.05). Fundoplication type (p = 0.166), gastropexy, or mesh was not associated with an increased likelihood of resolution (OR 0.855 CI 0.326-2.243; p = 0.05) (OR 0.440 CI 0.150-1.287; p = 0.05).
CONCLUSIONS
CONCLUSIONS
Anemia occurs in 1 out of 4 patients with PEH and is more frequent in patients with larger hernias. Anemia is associated with a longer hospital stay and all-cause mortality after surgery. Anemia recurrence coincided with hernia recurrence in roughly two-thirds of patients.
Identifiants
pubmed: 37524917
doi: 10.1007/s00464-023-10302-8
pii: 10.1007/s00464-023-10302-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
8708-8713Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Addo A, Broda A, Reza Zahiri H, Brooks IM, Park A (2020) Resolution of anemia and improved quality of life following laparoscopic hiatal hernia repair. Surg Endosc 34(7):3072–3078. https://doi.org/10.1007/s00464-019-07054-9
doi: 10.1007/s00464-019-07054-9
pubmed: 31399944
Panzuto F, Di Giulio E, Capurso G, Baccini F, D’Ambra G, Delle Fave G, Annibale B (2004) Large hiatal hernia in patients with iron deficiency anaemia: a prospective study on prevalence and treatment. Aliment Pharmacol Ther 19:663–670
doi: 10.1111/j.1365-2036.2004.01894.x
pubmed: 15023168
Carrott PW, Markar SR, Hong J, Kuppusamy MK, Koehler RP, Low DE (2013) Iron-deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair. J Gastrointest Surg 17:858–862
doi: 10.1007/s11605-013-2184-7
pubmed: 23515913
Cheverie JN, Lam J, Neki K, Broderick RC, Lee AM, Matsuzaki T, Cubas R, Sandler BJ, Jacobsen GR, Fuchs KH, Horgan S (2020) Paraesophageal hernia repair: a curative consideration for chronic anemia? Surg Endosc 34:2243–2247
doi: 10.1007/s00464-019-07014-3
pubmed: 31346751
Haurani C, Carlin AM, Hammoud ZT, Velanovich V (2012) Prevalence and resolution of anemia with paraesophageal hernia repair. J Gastrointest Surg 16(10):1817–1820
doi: 10.1007/s11605-012-1967-6
pubmed: 22843082
Pauwelyn KA, Verhamme M (2005) Large hiatal hernia and iron deficiency anaemia: clinico-endoscopical findings. Acta Clin Belg 60(4):166–172. https://doi.org/10.1179/acb.2005.030
doi: 10.1179/acb.2005.030
pubmed: 16279396
Skipworth RJ, Staerkle RF, Leibman S, Smith GS (2014) Transfusion-dependent anaemia: an overlooked complication of paraoesophageal hernias. Int Sch Res Notices. 2014:479240. https://doi.org/10.1155/2014/479240
doi: 10.1155/2014/479240
pubmed: 27379280
pmcid: 4897576
Jones R, Simorov A, Lomelin D, Tadaki C, Oleynikov D (2015) Long-term outcomes of radiologic recurrence after paraesophageal hernia repair with mesh. Surg Endosc 29(2):425–430. https://doi.org/10.1007/s00464-014-3690-8
doi: 10.1007/s00464-014-3690-8
pubmed: 25030473
Hayden JD, Jamieson GG (2005) Effect on iron deficiency anemia of laparoscopic repair of large paraesophageal hernias. Dis Esophagus 18(5):329–331. https://doi.org/10.1111/j.1442-2050.2005.00508.x
doi: 10.1111/j.1442-2050.2005.00508.x
pubmed: 16197533
Verhoeff K, Dang JT, Deprato A, Kung JY, Switzer NJ, Birch DW, Wong C, Karmali S (2021) Surgical management of hiatal hernia vs medical therapy to treat bleeding Cameron lesions: a systematic review and meta-analysis. Surg Endosc 35(12):7154–7162. https://doi.org/10.1007/s00464-020-08135-w
doi: 10.1007/s00464-020-08135-w
pubmed: 33159296
Ruhl CE, Everhart JE (2001) Relationship of iron-deficiency anemia with esophagitis and hiatal hernia: hospital findings from a prospective, population-based study. Am J Gastroenterol 96(2):322–326. https://doi.org/10.1111/j.1572-0241.2001.03513.x
doi: 10.1111/j.1572-0241.2001.03513.x
pubmed: 11232670
Solomon D, Bekhor E, Kashtan H (2021) Paraesophageal hernia: to fundoplicate or not? Ann Transl Med 9(10):902. https://doi.org/10.21037/atm.2020.03.106
doi: 10.21037/atm.2020.03.106
pubmed: 34164536
pmcid: 8184421
Mark LA, Okrainec A, Ferri LE, Feldman LS, Mayrand S, Fried GM (2008) Comparison of patient-centered outcomes after laparoscopic Nissen fundoplication for gastroesophageal reflux disease or paraesophageal hernia. Surg Endosc 22(2):343–347. https://doi.org/10.1007/s00464-007-9628-7
doi: 10.1007/s00464-007-9628-7
pubmed: 18027047
Allman R, Speicher J, Rogers A, Ledbetter E, Oliver A, Iannettoni M, Anciano C (2021) Fundic gastropexy for high risk of recurrence laparoscopic hiatal hernia repair and esophageal sphincter augmentation (LINX) improves outcomes without altering perioperative course. Surg Endosc 35(7):3998–4002. https://doi.org/10.1007/s00464-020-07789-w
doi: 10.1007/s00464-020-07789-w
pubmed: 32681373
Chevrollier GS, Brown AM, Keith SW, Szewczyk J, Pucci MJ, Chojnacki KA, Rosato EL, Palazzo F (2019) Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair. Surg Endosc 33(2):535–542. https://doi.org/10.1007/s00464-018-6328-4
doi: 10.1007/s00464-018-6328-4
pubmed: 29998393
Clark LN, Helm MC, Higgins R, Lak K, Kastenmeier A, Kindel T, Goldblatt M, Gould JC (2018) The impact of preoperative anemia and malnutrition on outcomes in paraesophageal hernia repair. Surg Endosc 32(11):4666–4672. https://doi.org/10.1007/s00464-018-6311-0
doi: 10.1007/s00464-018-6311-0
pubmed: 29934871