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What are The Long-Term Outcomes of Laparoscopic Paraesophageal Hernia Repairs Without Mesh?
*Damien J Lazar1, Desmond H Birkett2, David M Brams2, *Heather A Ford2, Dmitry Nepomnayshy2
1Tufts University School of Medicine, Boston, MA;2Lahey Hospital and Medical Center, Burlington, MA

Objective: To determine long-term patient-specific outcomes of primary paraesophageal hernia (PEH) repair.
Design: Survey .
Setting: Tertiary Referral Center.
Patients: Chart review identified 217 patients with PEH repair between 2000 and 2012 without the use of mesh.
Interventions: Questionnaires mailed to patients.
Main Outcome Measures: Self reported outcomes of reoperation, symptom control, patient satisfaction, and quality of life.
Results: Out of 217 patients, 19 were deceased and 109 (53.5%) returned completed questionnaires. 87 respondents had undergone laparoscopic repair, and 19 had undergone open repair, with mean times from surgery of 6.6 years (sd=3.9) and 7.0 years (sd=4.1), respectively. Reoperation rate was 9.9% (n=8) and 5.3% (n=1) for laparoscopic and open repair groups (p=0.720). 95.4% (n=82) of laparoscopic and 89.5% (n=17) of open repair patients indicated that dysphagia, heartburn, and regurgitation improved following surgery (p=0.318). 73.6%% (n=64) and 77.8% (n=7) of laparoscopic and open repair patients responded that symptoms are currently controlled (p=0.320), with 54.0% (n=47) of laparoscopic and 26.3% (n=5) of open repair patients still requiring medication (p=0.029). 90.6% (n=78) and 89.5% (n=17) in the laparoscopic and open groups, respectively, stated that they would still choose to have the operation in retrospect (p=0.713).
Conclusions: Mesh placement for PEH is controversial. In this study, we show that laparoscopic and open PEH repair without mesh lead to favorable long-term outcomes in a majority of patients including low rates of reoperation, high satisfaction, and good symptom control - although half of those undergoing laparoscopic repair will require medication to achieve it. This is one of a few studies describing long term patient specific outcomes that are useful when counseling patients about laparoscopic PEH repair


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