Abstract：
BACKGROUND: Hiatal hernia (HH) repairs have been associated with high recurrence rates. This study aimed to investigate if changes in patient\'s self-reported GERD health-related quality of life (HRQL) scores over time are associated with long-term surgical outcomes.
METHODS: Retrospective chart reviews were conducted on all patients who had laparoscopic or robotic HH repairs between 2018 and 2022 at a tertiary care center. Information was collected regarding initial BMI, endoscopic HH measurement, surgery, and pre- and post-operative HRQL scores. Repeat imaging at least a year following surgical repair was then evaluated for any evidence of recurrence. Paired t tests were used to compare pre- and post-operative HRQL scores. Wilcoxon ranked-sum tests were used to compare the HRQL scores between the recurrence cohort and non-recurrence cohorts at different time points.
RESULTS: A total of 126 patients underwent HH repairs and had pre- and post-operative HRQL scores. Mesh was used in 23 repairs (18.25%). 42 patients had recorded HH recurrences (33.3%), 35 had no evidence of recurrence (27.7%), and 49 patients (38.9%) had no follow-up imaging. The average pre-operative QOL score was 24.99 (SD ± 14.95) and significantly improved to 5.63 (SD ± 8.51) at 2-week post-op (p < 0.0001). That improvement was sustained at 1-year post-op (mean 7.86, SD ± 8.26, p < 0.0001). The average time between the initial operation and recurrence was 2.1 years (SD ± 1.10). Recurrence was significantly less likely with mesh repairs (p = 0.005). There was no significant difference in QOL scores at 2 weeks, 3 months, 6 months, or 1 year postoperatively between the cohorts (p = NS).
CONCLUSIONS: Patients had significant long-term improvement in their HRQL scores after surgical HH repair despite recurrences. The need to re-intervene in patients with HH recurrence should be based on their QOL scores and not necessarily based on established recurrence.
METHODS: Retrospective chart reviews were conducted on all patients who had laparoscopic or robotic HH repairs between 2018 and 2022 at a tertiary care center. Information was collected regarding initial BMI, endoscopic HH measurement, surgery, and pre- and post-operative HRQL scores. Repeat imaging at least a year following surgical repair was then evaluated for any evidence of recurrence. Paired t tests were used to compare pre- and post-operative HRQL scores. Wilcoxon ranked-sum tests were used to compare the HRQL scores between the recurrence cohort and non-recurrence cohorts at different time points.
RESULTS: A total of 126 patients underwent HH repairs and had pre- and post-operative HRQL scores. Mesh was used in 23 repairs (18.25%). 42 patients had recorded HH recurrences (33.3%), 35 had no evidence of recurrence (27.7%), and 49 patients (38.9%) had no follow-up imaging. The average pre-operative QOL score was 24.99 (SD ± 14.95) and significantly improved to 5.63 (SD ± 8.51) at 2-week post-op (p < 0.0001). That improvement was sustained at 1-year post-op (mean 7.86, SD ± 8.26, p < 0.0001). The average time between the initial operation and recurrence was 2.1 years (SD ± 1.10). Recurrence was significantly less likely with mesh repairs (p = 0.005). There was no significant difference in QOL scores at 2 weeks, 3 months, 6 months, or 1 year postoperatively between the cohorts (p = NS).
CONCLUSIONS: Patients had significant long-term improvement in their HRQL scores after surgical HH repair despite recurrences. The need to re-intervene in patients with HH recurrence should be based on their QOL scores and not necessarily based on established recurrence.
摘要：
背景：食管裂孔疝（HH）修复与高复发率相关。本研究旨在调查患者自我报告的GERD健康相关生活质量(HRQL)评分随时间的变化是否与长期手术结果相关。
方法：对2018年至2022年在三级护理中心进行腹腔镜或机器人HH修复的所有患者进行了回顾性图表回顾。收集了关于初始BMI的信息，内窥镜HH测量，手术,术前和术后HRQL评分。然后评估手术修复后至少一年的重复成像是否有任何复发的证据。配对t检验用于比较术前和术后HRQL评分。使用Wilcoxon排名和检验来比较不同时间点复发队列和非复发队列之间的HRQL评分。
结果：共有126例患者接受了HH修复，并有术前和术后HRQL评分。网格用于23次维修（18.25％）。42例患者记录HH复发（33.3％），35人没有复发的证据（27.7%），49例患者（38.9%）没有随访影像学检查。术前平均QOL评分为24.99(SD±14.95),术后2周时显著提高至5.63(SD±8.51)(p<0.0001)。这种改善在术后1年持续(平均7.86,SD±8.26,p<0.0001)。初次手术至复发的平均时间为2.1年（SD±1.10）。网状修复的复发可能性明显较小（p=0.005）。2周时QOL评分无显著差异,3个月,6个月,或术后1年之间的队列（p=NS）。
结论：患者术后HH修复术后HRQL评分有长期显著改善，尽管复发。对HH复发患者重新干预的需要应基于其QOL评分，而不一定基于已确定的复发。
方法：对2018年至2022年在三级护理中心进行腹腔镜或机器人HH修复的所有患者进行了回顾性图表回顾。收集了关于初始BMI的信息，内窥镜HH测量，手术,术前和术后HRQL评分。然后评估手术修复后至少一年的重复成像是否有任何复发的证据。配对t检验用于比较术前和术后HRQL评分。使用Wilcoxon排名和检验来比较不同时间点复发队列和非复发队列之间的HRQL评分。
结果：共有126例患者接受了HH修复，并有术前和术后HRQL评分。网格用于23次维修（18.25％）。42例患者记录HH复发（33.3％），35人没有复发的证据（27.7%），49例患者（38.9%）没有随访影像学检查。术前平均QOL评分为24.99(SD±14.95),术后2周时显著提高至5.63(SD±8.51)(p<0.0001)。这种改善在术后1年持续(平均7.86,SD±8.26,p<0.0001)。初次手术至复发的平均时间为2.1年（SD±1.10）。网状修复的复发可能性明显较小（p=0.005）。2周时QOL评分无显著差异,3个月,6个月,或术后1年之间的队列（p=NS）。
结论：患者术后HH修复术后HRQL评分有长期显著改善，尽管复发。对HH复发患者重新干预的需要应基于其QOL评分，而不一定基于已确定的复发。
