Abstract：
BACKGROUND: Paraesophageal hernia repairs (PEHRs) have high rates of radiographic recurrence, with some patients requiring repeat operation. This study characterizes patients who underwent PEHR to identify the factors associated with postoperative symptom improvement and radiographic recurrence. We furthermore use propensity score matching to compare patients undergoing initial and reoperative PEHR to identify the factors predictive of recurrence or need for reoperation.
METHODS: After IRB approval, patients who underwent PEHR at a tertiary care center between January 2018 and December 2022 were identified. Patient characteristics, preoperative imaging, operative findings, and postoperative outcomes were recorded. A computational generalization of inverse propensity score weight was then used to construct populations of initial and redo PEHR patients with similar covariate distributions.
RESULTS: A total of 244 patients underwent PEHR (78.7% female, mean age 65.4 ± 12.3 years). Most repairs were performed with crural closure (81.4%) and fundoplication (71.7%) with 14.2% utilizing mesh. Postoperatively, 76.5% of patients had subjective symptom improvement and of 157 patients with postoperative imaging, 52.9% had evidence of radiographic recurrence at a mean follow-up of 10.4 ± 13.6 months. Only 4.9% of patients required a redo operation. Hernia type, crural closure, fundoplication, and mesh usage were not predictors of radiographic recurrence or symptom improvement (P > 0.05). Propensity weight score analysis of 50 redo PEHRs compared to a matched cohort of 194 initial operations revealed lower rates of postoperative symptom improvement (P < 0.05) but no differences in need for revision, complication rates, ED visits, or readmissions.
CONCLUSIONS: Most PEHR patients have symptomatic improvement with minimal complications and reoperations despite frequent radiographic recurrence. Hernia type, crural closure, fundoplication, and mesh usage were not significantly associated with recurrence or symptom improvement. Compared to initial PEHR, reoperative PEHRs had lower rates of symptom improvement but similar rates of recurrence, complications, and need for reoperation.
METHODS: After IRB approval, patients who underwent PEHR at a tertiary care center between January 2018 and December 2022 were identified. Patient characteristics, preoperative imaging, operative findings, and postoperative outcomes were recorded. A computational generalization of inverse propensity score weight was then used to construct populations of initial and redo PEHR patients with similar covariate distributions.
RESULTS: A total of 244 patients underwent PEHR (78.7% female, mean age 65.4 ± 12.3 years). Most repairs were performed with crural closure (81.4%) and fundoplication (71.7%) with 14.2% utilizing mesh. Postoperatively, 76.5% of patients had subjective symptom improvement and of 157 patients with postoperative imaging, 52.9% had evidence of radiographic recurrence at a mean follow-up of 10.4 ± 13.6 months. Only 4.9% of patients required a redo operation. Hernia type, crural closure, fundoplication, and mesh usage were not predictors of radiographic recurrence or symptom improvement (P > 0.05). Propensity weight score analysis of 50 redo PEHRs compared to a matched cohort of 194 initial operations revealed lower rates of postoperative symptom improvement (P < 0.05) but no differences in need for revision, complication rates, ED visits, or readmissions.
CONCLUSIONS: Most PEHR patients have symptomatic improvement with minimal complications and reoperations despite frequent radiographic recurrence. Hernia type, crural closure, fundoplication, and mesh usage were not significantly associated with recurrence or symptom improvement. Compared to initial PEHR, reoperative PEHRs had lower rates of symptom improvement but similar rates of recurrence, complications, and need for reoperation.
摘要：
背景：食管旁疝修补术（PEHRs）具有较高的影像学复发率，有些病人需要重复手术。这项研究描述了接受PEHR的患者，以确定与术后症状改善和影像学复发相关的因素。此外，我们还使用倾向评分匹配来比较接受初次和再次手术PEHR的患者，以确定复发或需要再次手术的预测因素。
方法：IRB批准后，我们确定了2018年1月至2022年12月期间在三级医疗中心接受PEHR的患者.患者特征,术前成像,手术发现，并记录术后结局.然后使用逆倾向得分权重的计算概括来构建具有相似协变量分布的初始和重做PEHR患者群体。
结果：共有244例患者接受了PEHR（78.7％为女性，平均年龄65.4±12.3岁)。大多数修补术是用小腿闭合（81.4％）和胃底折叠（71.7％）进行的，其中14.2％使用网状物。术后,76.5%的患者主观症状改善,157例患者术后影像学检查,平均随访10.4±13.6个月时，52.9％的人有影像学复发的证据。只有4.9％的患者需要重做手术。疝类型,cruralclosure,胃底折叠术,和网片的使用不是影像学复发或症状改善的预测因素（P>0.05）。50例重做PEHRs的倾向体重评分分析与194例初始手术的匹配队列相比，显示术后症状改善率较低（P<0.05），但在需要翻修方面没有差异。并发症发生率,ED访问，或再入院。
结论：大多数PEHR患者尽管经常复发，但症状改善，并发症和再次手术。疝类型,cruralclosure,胃底折叠术,和网状物的使用与复发或症状改善没有显着相关。与最初的PEHR相比，再次手术PEHRs的症状改善率较低，但复发率相似，并发症,需要重新手术。
方法：IRB批准后，我们确定了2018年1月至2022年12月期间在三级医疗中心接受PEHR的患者.患者特征,术前成像,手术发现，并记录术后结局.然后使用逆倾向得分权重的计算概括来构建具有相似协变量分布的初始和重做PEHR患者群体。
结果：共有244例患者接受了PEHR（78.7％为女性，平均年龄65.4±12.3岁)。大多数修补术是用小腿闭合（81.4％）和胃底折叠（71.7％）进行的，其中14.2％使用网状物。术后,76.5%的患者主观症状改善,157例患者术后影像学检查,平均随访10.4±13.6个月时，52.9％的人有影像学复发的证据。只有4.9％的患者需要重做手术。疝类型,cruralclosure,胃底折叠术,和网片的使用不是影像学复发或症状改善的预测因素（P>0.05）。50例重做PEHRs的倾向体重评分分析与194例初始手术的匹配队列相比，显示术后症状改善率较低（P<0.05），但在需要翻修方面没有差异。并发症发生率,ED访问，或再入院。
结论：大多数PEHR患者尽管经常复发，但症状改善，并发症和再次手术。疝类型,cruralclosure,胃底折叠术,和网状物的使用与复发或症状改善没有显着相关。与最初的PEHR相比，再次手术PEHRs的症状改善率较低，但复发率相似，并发症,需要重新手术。
