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S A T A b st ra ct s performed or reduce postoperative dysphagia. Methods and Procedures: We performed a retrospective review of all patients undergoing PEH repair between January 2011 and July 2014. Demographic, preoperative, operative, and outcome data were collected prospectively and maintained in an IRB approved database. The primary outcome measures included the type of fundoplication performed and post-operative dysphagia scores. Secondary outcomes included disease specific quality of life scores (GERD-HRQL) and patient satisfaction. Data were analyzed using Stata 12 software (Stata Corporation, College Station, TX) with significance set at p < 0.05. Results: One hundred twenty-five patients underwent laparoscopic PEH repair during the study period. Forty-seven (37%) patients underwent preoperative manometry, and 78 (62%) did not. The mean age was 65.6±14.3 years and 87 (70%) were female with a mean body mass index (BMI) of 29.9±5.8 kg/m2. Patients who did not undergo manometry were older (67.9 vs. 61.7, p=0.02), but the groups did not differ in terms of BMI, gender, Proton Pump Inhibitor (PPI) use, baseline dysphagia score, baseline GERDHRQL score or type of fundoplication performed. At a median follow-up of 16 months (range 4 44 months), the median dysphagia score was 0 for both groups (p=0.41). Five (14%) patients in the no manometry group required endoscopic dilation compared to 3 (17%) in the manometry group (p=0.76). Median GERD-HRQL score improved significantly in both the no manometry and manometry groups (7 vs. 2, p

Background: Esophageal perforation is an important therapeutic challenge. The aim of this study was to review the outcomes of esophageal perforations treated by a specialized unit in esophageal surgery. Methods: We performed a retrospective review of 52 consecutive patients with non-neoplasic esophageal perforation, between January 1991 and December 2008. Demographics, cause and location of perforation, time of diagnosis, management results and outcomes were evaluated. The management and outcomes trends over time were evaluated. For that, the cases were catalogued in three groups of 6 consecutive years. Results: Spontaneous perforation occurred in 9 (17,3%) patients. Iatrogenic perforations were present in 15 (28,8%) patients and 28 (53,8%) patients had traumatic perforations. In half of the patients diagnosis was done in the first 24 hours. The perforation's location was cervical in 14 (26,9%) cases, thoracic in 31 (59,6%) and abdominal in 7 (13,5%). The traumatic perforations were diagnosed significantly later than the other causes (p=0,02). In 9 patients (17,3%) the treatment was non-operatively. For the patients submitted to surgery (82,7%), a primary repair was done in 23 cases (53,5%), a bipolar exclusion was performed in 18 (41,9%) and a conservative operative approach (drainage only) performed in 2 (3,8%). There were significant differences in the type of operative treatment according to the location (p=0,035) [thoracic perforations were more times treated with bipolar exclusion]. In the analysis of the trends over time, there were significant differences in the location (p=0,027) and the type of management (p=0,012) [more patients treated surgically with primary repair in the last periods]. The morbidity and mortality rates were 46,2% and 13,5%, respectively. There were significant differences in morbidity according to the cause of perforation (p= 0,047) [the iatrogenic perforations had less morbidity] and the type of management (p= 0,041) [the patients treated conservative either operatively or non-operatively had lower morbidity rate], but only the type of management was an independent risk factor in the logistic regression analysis (OR 0,071, CI95% 0,007-0,696, p=0,003). There were significant differences in mortality according to the age (p=0,022) [older patients with higher mortality rate] and age was an independent risk factor in multivariate analysis (OR 1,095, CI95% 1,003-1,196, p=0,005). There weren't significant differences in morbidity and mortality rate over time. Conclusion: An approach to esophageal perforation based on injury severity and the degree of mediastinal and pleural contamination is of paramount importance. Although operative management remains the standard in the majority of patients with esophageal perforation, non-operative management may be successfully implemented in selected patients with a low morbidity rate.

We wished to evaluate the long-term effectiveness of the laparoscopic Hill repair in the treatment of type III hiatal hernia. Fifty-two patients underwent laparoscopic repair of a type III hiatal hernia. No esophageal lengthening procedures were performed. Short esophagus was determined from the operative record. Late symptomatic follow-up and a satisfaction questionnaire were completed in 71% (37/52) of patients at a mean of 39 months (range 6 to 84 months). Esophagrams were completed in 65% (34/52) of patients at a mean of 3 7 months (range to 84 months) after repair. Eighty-one percent were without any adverse symptoms, and 86% rated outcome as excellent or good at 39 months. Symptoms requiring treatment were present in 19% (7/37). Esophagrams revealed a recurrent hernia in 32% (11/34) of patients of whom 36% (4/11) were asymptomatic. Six patients with short esophagus underwent esophagram with one recurrence identified (17%). This was compared with 28 patients without short esophagus, of whom 10 had a recurrence (35%) (P = 0.70). The laparoscopic Hill repair provides long-term satisfaction and relief of symptoms. The incidence of anatomic recurrence on video esophagram is high and does not always correlate with symptoms. The presence of short esophagus does not play a role in recurrence when the Hill repair is used.