Defining Clinically Significant Radiographic Recurrence after Paraesophageal Hernia Repair: Post-Hoc Analysis of...

Area of Science:

• Gastroenterology and Surgical Innovation
• Hernia Repair Outcomes
• Patient-Reported Outcome Measures

Background:

• Minimally invasive paraesophageal hernia repair (MIS-PEHR) recurrence is often defined pragmatically as >2 cm herniation.
• The clinical significance of this >2 cm threshold, particularly regarding patient outcomes, requires further investigation.

Purpose of the Study:

• To evaluate the correlation between radiographic recurrence size and reoperation rates after MIS-PEHR.
• To assess the relationship between recurrence size and patient-reported outcomes, including quality of life and symptom severity.

Main Methods:

• Post-hoc analysis of a prospective randomized clinical trial (NCT04007952) involving 174 adult patients with paraesophageal hernia >5 cm undergoing MIS-PEHR.
• Recurrence was categorized (0 cm, 0-2 cm, 2-5 cm, >5 cm), and outcomes included 1-year reoperation rates and GERD-HRQL and FASL scores.

Main Results:

• Reoperation rates were 0% for <2 cm recurrence, 7.5% for 2-5 cm, and 23.1% for >5 cm (P<.0001).
• Patient-reported outcomes (GERD-HRQL, heartburn scores) were significantly worse for recurrences >2 cm compared to 0 cm (P≤.0001).
• No significant difference in outcomes was observed between 2-5 cm and >5 cm recurrence groups.

Conclusions:

• Radiographic recurrence >2 cm after MIS-PEHR is associated with increased reoperation rates and poorer patient-reported outcomes at 1 year.
• The data support >2 cm as a clinically significant definition of recurrence, while the relevance of 0-2 cm recurrences remains unclear.