Long-term surgical outcomes for the surgical management of complete intrathoracic stomach (CIS)

Surgery is indicated for symptomatic CIS patients to avoid complications (volvulus, obstruction and strangulation) associated with high morbidity and even mortality. There remains limited evidence of the long-term outcomes and improvement of symptoms from this procedure. Previous studies have been unable to compare preoperative symptoms with post-operative data. Although it appears the procedure has favourable outcomes, further data are required to demonstrate a significant improvement in quality of life (QoL). We therefore aim to assess the long-term outcomes, including changes to QoL and satisfaction, for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%).

Prospective data were collected from 154 consecutive GPEH (Giant Hiatus Hernia) patients intervened between March 2008 and March 2023 in a large DGH. Retrospective analysis of this identified 34 patients with CIS. All patients underwent a laparoscopic repair with mesh, apart from one patient who underwent conversion to open gastropexy. Outcome measures included both pre-operative and post-operative standardised GERD-Health-Related Quality of Life Questionnaire (GERD-QOL) scores; complications; and patient satisfaction.

34 patients were included (11 male:23 female) with a mean age 72 (45-83) years. All patients were symptomatic pre-operatively with heartburn (59%), dysphagia (59%), retrosternal discomfort (53%), vomiting (41%), weight loss (41%) or shortness of breath (35%). There were 4 (12%) complications and 3 (9%) 30-day mortalities. Follow-up GERD-QOL questionnaires displayed 27/29 (93%) excellent scores (defined as total < 5) at 6 months and 15/21 (71%) excellent scores after a median follow up of 8.5 years. This demonstrated a significant improvement in long-term scores (p < 0.001).

Laparoscopic repair of complete intrathoracic stomach in this large single-centre study has demonstrated a significant improvement in symptoms and satisfaction over a median 8.5 years follow-up.