Deliberate pleurotomy in the surgical management of large hiatal hernias: Case series with 5-year follow-up

INTRODUCTION: The objective of this study was to demonstrate outcomes of cooperating with deliberate capnothorax in large hiatal hernia (LHH) surgery. Tension-free crural repair is one of the key tenets of hiatal hernia surgery. Achieving a tension-free crural repair in LHHs presents a technical challenge. Tension repairs are associated with anatomical failure of repair, hernia recurrence, higher symptom scores and poor quality of life (QoL). We present our outcomes with the use of a novel technique of incorporating a deliberate left pleurotomy to reduce crural tension in large hiatal defects. PATIENTS AND METHODS: Single-centre mixed cross-sectional review of pre-operative, surgical and 5-year follow-up data. Primary outcomes were gastro-oesophageal reflux disease health-related quality of life scores (GERD-HRQL) and gastro-oesophageal reflux symptom scores (GER-SS). Secondary outcomes were recurrence, post-operative respiratory complications and medication use. RESULTS: Eighty-six patients had hiatal hernia surgery, 48 patients had LHH. 68% of cases had deliberate pleurotomy as part of their surgical technique. QoL scores using the GERD-HRQL were 43.2, 2.7 and 4.3 in the pre-operative, early and late post-operative periods, respectively. The symptom scores using the GER SS were 36, 1.2, and 3.0 in the pre-operative, early and late post-operative periods, respectively. Only one recurrence that required reoperation was reported, but no respiratory complications were reported. CONCLUSIONS: Deliberate left pleurotomy to create capnothorax can be safely incorporated in the surgical technique of LHH repair to reduce crural tension for a tension-free crural repair.