Effects of Spinal Deformities on Hiatal Hernia Occurrence and Recurrence.

Hiatal hernia Hiatal hernia repair Kyphosis Lordosis Scoliosis

Journal

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084

Informations de publication

Date de publication:
06 Nov 2023
Historique:
received: 27 08 2023
accepted: 18 10 2023
medline: 7 11 2023
pubmed: 7 11 2023
entrez: 6 11 2023
Statut: aheadofprint

Résumé

Spinal deformities such as kyphosis, lordosis, and scoliosis have demonstrated a possible association between these deformities. Our hypothesis is that the presence of spinal deformities will increase the risk of hiatal hernia recurrence after repair. The following data was retrospectively gleaned for patients undergoing hiatal hernia repair (1997-2022): age, sex, date of hiatal hernia repair, presence and type of spinal deformity, Cobb angle, type of hiatal hernia and size, type of hiatal hernia repair, recurrence and size, time to recurrence, reoperation, type of reoperation, and time to reoperation. Spinal deformities were present in 15.8% of 546 patients undergoing hiatal hernia repair, with a distribution of 21.8% kyphosis, 2.3% lordosis, 58.6% scoliosis, and 17.2% multiple. There was no difference in sex or age between groups. Spinal deformity patients were more likely to have types III and IV hiatal hernias (52.3% vs. 38.9%, p = 0.02) and larger hernias (median 5 [3-8] vs. 4 [2-6], p = 0.01). There was no difference in access, fundoplication use, or mesh use between groups. However, these patients had a higher recurrence rate (47.7% vs 30.0%, p = 0.001) and a shorter time to recurrence (months) (10.3 [5.6-25.1] vs 19.2 [9.8-51.0], p = 0.02). Cobb angle did not affect recurrence. Spinal deformity patients were more likely to have more complex and larger hiatal hernias. They were at higher risk of hiatal hernia recurrence after repair with shorter times to recurrence. This is a group that requires special attention with additional preoperative counseling and possibly use of surgical adjuncts in repair.

Sections du résumé

BACKGROUND BACKGROUND
Spinal deformities such as kyphosis, lordosis, and scoliosis have demonstrated a possible association between these deformities. Our hypothesis is that the presence of spinal deformities will increase the risk of hiatal hernia recurrence after repair.
METHODS METHODS
The following data was retrospectively gleaned for patients undergoing hiatal hernia repair (1997-2022): age, sex, date of hiatal hernia repair, presence and type of spinal deformity, Cobb angle, type of hiatal hernia and size, type of hiatal hernia repair, recurrence and size, time to recurrence, reoperation, type of reoperation, and time to reoperation.
RESULTS RESULTS
Spinal deformities were present in 15.8% of 546 patients undergoing hiatal hernia repair, with a distribution of 21.8% kyphosis, 2.3% lordosis, 58.6% scoliosis, and 17.2% multiple. There was no difference in sex or age between groups. Spinal deformity patients were more likely to have types III and IV hiatal hernias (52.3% vs. 38.9%, p = 0.02) and larger hernias (median 5 [3-8] vs. 4 [2-6], p = 0.01). There was no difference in access, fundoplication use, or mesh use between groups. However, these patients had a higher recurrence rate (47.7% vs 30.0%, p = 0.001) and a shorter time to recurrence (months) (10.3 [5.6-25.1] vs 19.2 [9.8-51.0], p = 0.02). Cobb angle did not affect recurrence.
CONCLUSIONS CONCLUSIONS
Spinal deformity patients were more likely to have more complex and larger hiatal hernias. They were at higher risk of hiatal hernia recurrence after repair with shorter times to recurrence. This is a group that requires special attention with additional preoperative counseling and possibly use of surgical adjuncts in repair.

Identifiants

DOI: 10.1007/s11605-023-05877-5 PMID: 37932593
pubmed: 37932593
doi: 10.1007/s11605-023-05877-5
pii: 10.1007/s11605-023-05877-5
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023. The Society for Surgery of the Alimentary Tract.

Références

Vega JA Jr, Velanovich V. Paraesophageal hernia. Etiology, presentation, and indications for repair. In: Yeo CJ, DeMeester SR, McFadden DW, Matthews JB, Fleshman JW (Eds.). Shakelford’s Surgery of the Alimentary Tract,8 New York, Elsevier, 2018, pp. 279-283
Velanovich V. Practice-changing milestones in anti-reflux and hiatal hernia surgery: A single surgeon perspective over 27 years and 1,200 operations. J Gastrointest Surg 2021;25:2757-2769
doi: 10.1007/s11605-021-04940-3 pubmed: 33532979
Velanovich V, Saad AR. Toward a unified theory of occurrence and recurrence of hiatal hernia. Surgery 2020;168:1170-1173
doi: 10.1016/j.surg.2020.07.060 pubmed: 33036781
Polomsky M, Peter JH, Schwartz SI. Hiatal hernias and disorders of the spine: A historical perspective. Dis Esophagus 2012:25:367-372
doi: 10.1111/j.1442-2050.2011.01263.x pubmed: 22026822
Kim H, Kim HS, Moon ES, et al. Scoliosis Imaging: What the radiologist should know. RadioGraphics 2010;30:1823-1842
doi: 10.1148/rg.307105061 pubmed: 21057122
Tran TH, Wing D, Davis A, et al. Correlations among four measures of thoracic kyphosis in older adults. Osteoporosis Int 2016;27:1255-1259
doi: 10.1007/s00198-015-3368-7
Bennett RD, Straughn DM, Velanovich V. Gastroesophageal reflux disease, hiatal hernia, and Barrett esophagus. In: Zinner, MJ; Ashley, SW, Hines, OJ (Eds.). Maingot’s Abdominal Operations, 13 New York, McGraw-Hill Education, 2019, pp. 393-422
Kusano M, Hashizume K, Ehara Y, et al. Size of hiatus hernia correlates with severity of kyphosis, not with obesity, in elderly Japanese women. J Clin Gastroenterol 2018;42:345-350
doi: 10.1097/MCG.0b013e318037556c
Polomsky M, Siddall KA, Salvador R, et al. Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach: A link toward understanding pathogenesis. J Am Coll Surg 2009;208:562-569
doi: 10.1016/j.jamcollsurg.2009.01.004 pubmed: 19476791
Masaoka A, Kundo S, Yano M, et al. Thoracic deformity and hiatal hernia (intrathoracic stomach) in the elderly. J Thorac Imaging 2012;27:372-375
doi: 10.1097/RTI.0b013e3182698e99 pubmed: 23047732
Saad AR, Velanovich V. Anatomic observations of recurrent hiatal hernia: Recurrence or disease progression? J Am Coll Surg 2020;230:999-1007
doi: 10.1016/j.jamcollsurg.2020.03.011 pubmed: 32217191

Auteurs

Naveen Perisetla (N)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

William N Doyle (WN)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

Lauren Ladehoff (L)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

Nicole Natarelli (N)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

Valerie Nemov (V)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

Karthik Pittala (K)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

Joseph Sujka (J)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

Adham R Saad (AR)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

Chistopher DuCoin (C)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.

Vic Velanovich (V)

Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA. vvelanov@usf.edu.
ORCID: 0000-0003-0133-948X

Classifications MeSH