2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
their weight after effective treatment with Heller myotomy.
Heller myotomy with simultaneous duodenal switch has been
described as one treatment option. However, reflux and pathological
malabsorbtion are potential complications that may
limit the effectiveness of this procedure. Although it has never
been reported, LRYGB with combined Heller myotomy is
another feasible therapeutic option. However, the effect of a
restrictive procedure (LRYGB) in the setting of esophageal dysmotility
is unclear. Our short term results indicate that LRYGB
can yield typical weight loss results of gastric bypass surgery
with resolution of dysphagia. Creating a larger gastro-jejunostomy
(2.5cm) may reduce the risk of postoperative dysphagia.
Finally, because the gastric pouch has minimal acid production,
the risk of pathological acid reflux is reduced.
P259–Esophageal/Gastric Surgery
OUTCOMES OF LAPAROSCOPIC PARAESOPHAGEAL HERNIA
REPAIR: 49 CONSECUTIVE CASES IN A RURAL CENTER,
Vittorio Lombardo MD, Carly Stell BS,Yaron Perry MD,Salman
Malik MD,Craig Wood BS,Anthony T Petrick MD, Geisinger
Medical Center
INTRO: Patient referrals for laparoscopic paraesophageal hernia
repair (LPHR) have recently increased in our center.. Recent
series have advocated the laparoscopic approach. No large
studies of LPHR have been reported in a rural population. Our
objective is to analyze the outcomes of our initial experience
with LPHR. METHODS: Retrospective data was obtained
through a GERD/dysphagia questionnaire, review of UGI and
electronic medical records. Statistical significance was calculated
using student?s t-test. RESULTS: The mean age of 49
consecutive patients was 67.1±14.8 with a 1:2.5 M:F ratio.
Preop UGI and EGD demonstrated a PEH in 95% and 92% of
patients respectively. Collis gastroplasty and Nissen were performed
in 86% and only Nissen in 14%. Crural repair was performed
in all patients. Median LOS was 3.5 days (range 2- 9
days). 98% completed at least one postop questionnaire at a
mean of 12.7 months and 80% had an UGI at least 3 mo
postop (mean=12.2mo). UGI was normal 90% and 10% had
recurrence of paraesophageal hernia. Major complications
occurred in 12%. Mortality was 2.0%(n=1). Results were reported
as excellent in 41%, good in 43%, fair in 10% and poor in
6%.
Outcomes of LPHR
Symptoms Preop Postop
Heartburn 80% (n=39) 6.1% (n=3)*
Regurg/Emesis 71% (n=35) 6.1% (n=3)*
Dysphagia 41% (n=20) 12% (n=6))*
Epigastic pain 33% (n=16) 2.0% (n=1)*
PPI's 76% (n=38) 18% (n=9)*
* = p