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J Thorac Cardiovasc Surg 2009;137:419-424
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Fatal complications of adult paraesophageal hernia: A population-based study

Eero I. Sihvo, MD, PhDa, Jarmo A. Salo, MD, PhDa,*, Jari V. Räsänen, MD, PhDa, Tuomo K. Rantanen, MD, PhDb

a Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland
b Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland

Received for publication January 23, 2008; revisions received April 18, 2008; accepted for publication May 18, 2008.

* Address for reprints: Jarmo A. Salo, MD, PhD, Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, PO Box 340, Haartmaninkatu 4, FIN-00029 HUS, Helsinki, Finland. (Email: jarmo.salo{at}hus.fi).

Objectives: Data on mortality from paraesophageal hernia are scarce. This study focused on mortality associated with its natural history or conservative treatment.

Methods: For this population-based retrospective study, Finland's administrative databases provided preliminary data. Among 333 patients who died from benign esophageal diseases or hiatal hernias, analysis of medical records led us to include 32.

Results: From 1987 through 2001 in Finnish hospitals, 563 patients underwent surgical intervention and 67 underwent conservative treatment for paraesophageal hernia. This hernia caused death (mortality, 0.6/1,000,000 of the adult population; 95% confidence interval, 0–1.8/1,000,000) in 32 patients, 29 (91%) with concomitant diseases. The overall mortality rate for the 563 having surgical treatment was 2.7% (15 patients). Three died after elective repair. Of 67 patients hospitalized for symptomatic paraesophageal hernia and treated conservatively, 11 (16.4%) died in the hospital within a mean of 42 months (range, 2–96 months) from onset of symptoms. Four (13%) deaths might have been prevented by elective surgical intervention. Of the 32 deceased patients, 4 (12.5%) had type II, 16 (50%) had type III, and 9 (28.1%) had type IV hiatal hernias. In 3 (9.4%) patients type remained unknown. Death resulted from incarceration in 24 (75%), complications of surgical intervention in 6 (18.8%), and bleeding ulcer in 2 (6.2%).

Conclusions: Overall, most deaths were related to type III or IV hernias in aged patients with concomitant diseases, with those with severe symptoms requiring hospitalization at significant risk. Except for those at high surgical risk, we recommend repair of the paraesophageal hernia, at least in symptomatic patients.

Abbreviations and Acronyms CI = confidence interval; GERD = gastroesophageal reflux disease






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