Keywords
Abstract
Introduction: In surgical practice, hiatal hernias are often related to gastro esophageal reflux disease treatment in which continuous proton pump inhibitor administration is very successful. In large hiatal hernias, life threatening complications may occur. However, planned surgical repair of hiatal hernias is associated with very good functional outcomes with a low risk of postoperative complications. The incidence of large hiatal hernias grows with increasing age of the patient. In geriatric patients, internal comorbidities are also more frequent, including serious conditions. In these patients, one may hesitate whether to perform surgery with regard to the possible risk of postoperative complications. Conservative treatment of hiatal hernias is associated with a higher risk of stomach volvulus or severe bleeding as the most frequent complications.
Methods: We performed a retrospective study of patients operated on for a large hiatal hernia at the Department of Surgery, University Hospital Brno, between 2010 and 2016 (86 months). The patients were divided into 2 groups depending on the type of operation: acute (A) and elective (B). We evaluated demographic data, the nature of preoperative symptoms, type of surgery and postoperative complications.
Results: 120 patients were operated on for large hiatal hernia in this period of time. Group A involved 22 operated patients, group B 98 patients. There was a significantly higher number of laparotomies in the acute patient group compared to the elective group B (72.7 % vs. 23.5%, p<0.0001). Average surgery duration was longer in group A than in group B (133.8 minutes vs. 109.8 minutes). Postoperative complications were significantly more frequent in group A. They were also more severe and combined in a single patient. One death occurred in group A, in group B no patient died. Preoperative symptom analysis revealed a statistically significantly higher incidence of vomiting and breathing difficulties in group A. In group B, regurgitation and pyrosis were present with a significantly higher frequency.
Conclusion: In small hiatal hernias, the rate of complication occurrence is low. With growing size of the hernias, the risk of potentially life threatening acute complication increases. Stomach volvulus and severe bleeding in particular are the most frequent complications of hiatal hernias. Acute operations are associated with a significantly higher risk of postoperative complications than elective procedures. Surgical repair of hiatal hernia should be indicated in all symptomatic patients with a large hiatal hernia. In patients without clinical symptoms, surgical repair of hernia is recommended if there are no significant internal contraindications to surgery.