Patient-Centered Outcomes after Laparoscopic Paraesophageal Hernia Repair.

BACKGROUND: The aim of this study is to investigate patient-centered quality of life (QOL) outcomes in patients undergoing laparoscopic paraesophageal hernia repair. STUDY DESIGN: We prospectively followed patients who underwent laparoscopic paraesophageal hernia repair between 2009 and 2016. The QOL outcomes were measured using the 36-Item Short Form Health Survey, GERD Health Related Quality of Life, Reflux Symptom Index, and Dysphagia score surveys administered preoperatively and at 3 weeks, 6 months, 1 year, and 2 years postoperatively. Postoperative QOL outcomes were compared with preoperative baseline scores using paired t-tests. RESULTS: Of 314 total patients who underwent laparoscopic paraesophageal hernia repair, 188 with adequate follow-up were included in analysis. Mean age was 69.1 ± 11.8 years and 22.3% of studied subjects were male. Most of the cohort also underwent laparoscopic fundoplication (95.7%). Prevalent symptoms at initial presentation include heartburn (65.4%) and regurgitation (60.1%). Significant improvements between baseline and all postoperative time points were seen in Reflux Symptoms Index (3 weeks: p < 0.0001, 6 months: p = 0.005, 1 year: p = 0.0004, and 2 years: p = 0.002) and GERD Health Related Quality of Life scores (3 weeks: p < 0.0001, 6 months: p = 0.0019, 1 year: p < 0.0001, and 2 years: p = 0.0003). Dysphagia scores were worse at 3 weeks but lost significance at all other time points. The 36-Item Short Form Health Survey measures of Energy/Fatigue (p = 0.0099), Emotional Well-Being (p = 0.0393), Social Functioning (p = 0.0278), Pain (p = 0.0021), and Role Limitations Due to Physical Health (p = 0.0009) were significantly improved 2 years postoperatively. CONCLUSIONS: Laparoscopic paraesophageal hernia repair results in significantly improved QOL as measured by the 36-Item Short Form Health Survey at both short- and long-term intervals. Additionally, Reflux Symptom Index and GERD Health Related Quality of Life scores improved at all postoperative time points.