Ann Surg Treat Res.  2023 Dec;105(6):396-403. 10.4174/astr.2023.105.6.396.

The outcome of hiatal hernia repair and factors associated with surgical outcome in the pediatric population: a single-center experience

• Gang S
• Kwon H
• Park J
• Kim DY

• KMID: 2548784
• DOI: http://doi.org/10.4174/astr.2023.105.6.396

Abstract

Purpose
Hiatal hernia in children is a rare condition, and there is limited knowledge available about the disease itself. There is currently no agreement or consensus on the treatment of hiatal hernia in the pediatric population due to lack of evidence. In this study, we were to assess our experience with hiatal hernia, including the characteristics of our patients, surgical outcomes, and factors that influence the outcomes.
Methods
We retrospectively reviewed the medical records of 49 patients below the age of 18 years who underwent hiatal hernia repair at the Asan Medical Center between 2006 and 2021. We analyzed and compared the general characteristics and surgical outcomes based on the presence of recurrence and coexisting congenital diseases.
Results
Hiatal hernia progression was found to be associated with various medical conditions; however, no significant differences in patient characteristics or surgical outcomes between those with and without comorbidities were observed. There were no significant differences in patient characteristics or outcomes between the initial and redo operations. Fundoplication was performed in 19 patients (36.7%) during the initial operation and in 7 patients (87.5%) during repeat hiatal hernia repair.
Conclusion
The presence of an underlying disease didn’t influence the treatment and progression of hiatal hernia. Furthermore, there were no significant differences in the clinical course between patients with recurrent hiatal hernia and those experiencing it for the first time. Additionally, the impact of fundoplication on the recurrence of hiatal hernia in pediatric patients was found to be minimal.

Keyword

Causality; Fundoplication; Hiatal hernia; Recurrence; Treatment outcome

Figure

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  Fig. 1 Recurrence of hiatal hernia after repair (n = 10). Characteristics of patients with recurred hiatal hernia. (A) The number of patients with primary and secondary hiatal hernia was equal. (B) Reoperation was done in 8 patients (80.0%). (C) In 9 patients, the type of hiatal hernia was clarified. Four patients had type I and 3 patients were with type III. Two patients were diagnosed with type IV hiatal hernia.

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  Fig. 2 The effect of fundoplication in recurrence-free survival. No statistically significant difference was observed between patients who got fundoplication and those who didn’t in recurrence-free survival in Kaplan-Meier analysis (P = 0.139). This finding suggests that fundoplication didn’t show preventive effect on hiatal hernia recurrence.

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