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Title: Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias.
Austin Authors: Tog, Chek;Liu, David Shi Hao ;Lim, H K;Stiven, Peter Noel;Thompson, S K;Watson, D I;Aly, Ahmad 
Affiliation: Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
Division of Cancer Surgery Peter MacCallum Cancer Centre Melbourne Victoria Australia
University of Adelaide Discipline of Surgery Royal Adelaide Hospital Adelaide South Australia Australia
Flinders University Department of Surgery Flinders Medical Centre Bedford Park South Australia Australia
Issue Date: 28-Aug-2017 2017-06
Publication information: BJS open 2017; 1(3): 75-83
Abstract: Delayed gastric emptying can complicate surgery for hiatus hernia. The aim of this study was to quantify its incidence following laparoscopic repair of very large hiatus hernias, identify key risk factors for its occurrence and determine its impact on clinical outcomes. Data collected from a randomized trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (more than 50 per cent of stomach in chest) were analysed retrospectively. Delayed gastric emptying was defined as endoscopic evidence of solid food in the stomach after fasting for 6 h at 6 months after surgery. Delayed gastric emptying occurred in 19 of 102 patients (18·6 per cent). In univariable analysis, type 2 paraoesophageal hernia (relative risk (RR) 3·15, 95 per cent c.i. 1·41 to 7·06), concurrent anterior and posterior hiatal repair (RR 2·66, 1·14 to 6·18), hernia sac excision (RR 4·85, 1·65 to 14·24), 270°/360° fundoplication (RR 3·64, 1·72 to 7·68), division of short gastric vessels (RR 6·82, 2·12 to 21·90) and revisional surgery (RR 3·69, 1·73 to 7·87) correlated with delayed gastric emptying. In multivariable analysis, division of short gastric vessels (RR 6·27, 1·85 to 21·26) and revisional surgery (RR 6·19, 1·32 to 28·96) were independently associated with delayed gastric emptying. Delayed gastric emptying correlated with adverse gastrointestinal symptomatology, including higher rates of bloating, nausea, vomiting and anorexia, as well as reduced patient satisfaction with the operation and recovery. Delayed gastric emptying following large hiatus hernia repair is common and associated with adverse symptoms and reduced patient satisfaction. Division of short gastric vessels and revisional surgery were independently associated with its occurrence.
DOI: 10.1002/bjs5.11
ORCID: 0000-0001-8936-4123
PubMed URL: 29951609
Type: Journal Article
Appears in Collections:Journal articles

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