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Hiatal hernia after robotic-assisted coronary artery bypass graft surgery
Rami M Abazid1, Alireza Khatami1, Jonathan G Romsa1
1Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada.
Insights
Robotic-assisted coronary artery bypass grafting (RA-CABG) surgery is linked to a higher incidence and increased size of hiatal hernias (HH). Male gender emerged as a predictor for developing HH post-RA-CABG.
Area of Science:
- Cardiovascular Surgery
- Gastroenterology
- Medical Imaging
Background:
- Hiatal hernia (HH) is a condition where part of the stomach protrudes through the diaphragm.
- Robotic-assisted coronary artery bypass grafting (RA-CABG) is a minimally invasive surgical technique.
Purpose of the Study:
- To determine the incidence and progression of hiatal hernias (HH) following robotic-assisted coronary artery bypass grafting (RA-CABG).
Main Methods:
- Retrospective review of pre- and post-operative computed tomography (CT) scans from 491 patients who underwent RA-CABG between 2000 and 2017.
- Assessment of HH presence and size using CT scans, with a mean follow-up of 6.2 years for 155 patients with both pre- and post-operative imaging.
Main Results:
- Hiatal hernia prevalence increased from 28.4% pre-operatively to 41.3% post-operatively.
- The mean diameter and volume of hiatal hernias significantly increased after RA-CABG.
- A new hiatal hernia developed in 12.9% of patients, with male gender identified as a significant predictor (HR=3.038, P=0.033).
Conclusions:
- Robotic-assisted coronary artery bypass grafting is associated with an increased risk of developing hiatal hernias.
- RA-CABG also leads to an increase in the size of pre-existing hiatal hernias.
Background:
The aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery.
Methods:
We reviewed the pre- and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH.
Results:
We found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre- and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P<0.0001. The diameter of pre-existing HH 2.8 (±1.8) cm was significantly greater after surgery 3.9 (±2.5) cm, P<0.0001. As well the volume of the pre-existing HH 5.8 (4.4-9.2) mL (quartile) was significantly greater after surgery 14.1 (7.2-64.9) mL, P<0.0001. 20/155 (12.9%) had a newly developed HH after RA-CABG. A binary multivariate regression including HH risk factors showed that male gender is a predictor of developing a HH after RA-CABG with Hazard Ratio of 3.038, confidence interval (1.10-8.43), P=0.033.
Conclusions:
RA-CABG is associated with an increased risk of developing HH and increases the size of pre-existing HH.
