• Andrea Wirsching, Qing Zhang, Susan E McCormick, Michal Hubka, and Donald E Low.
• Department of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA.
• J. Am. Coll. Surg. 2018 Aug 1; 227 (2): 181-188.e2.

BackgroundAbnormal esophageal peristalsis diagnosed by high-resolution manometry is frequently found as part of the preoperative evaluation of patients with paraesophageal hernia (PEH). Currently, the clinical relevance of these findings is largely unknown.Study DesignFrom 2013 to 2016, two hundred and twelve patients undergoing PEH repair were prospectively recorded in an IRB-approved database. Preoperative high-resolution manometry was available for reanalysis according to the latest Chicago Classification (version 3.0) in 200 patients. Outcomes in patients with abnormal motility (AM) were compared with patients with normal motility (NM).ResultsAbnormal motility was documented in 106 (53%) patients. Abnormal motility was associated with older age (72 vs 69 years) and increased age-adjusted Charlson Comorbidity Index (both, p = 0.04). Compared with preoperative symptoms, postoperative retrosternal pain in AM vs NM patients went from 79% to 5% vs 75% to 2%, regurgitation from 52% to 2% vs 59% to 0%, and dysphagia from 56% to 7% vs 67% to 7%. An esophagogram was performed at a median of 4 months and 3.5 months postoperatively. Postoperative reflux in AM vs NM went from 54% to 21% vs 57% to 16%, and abnormal esophageal motility, visually assessed during the esophagogram, was stable (52% to 56% vs 41% to 48% for AM vs NM, respectively).ConclusionsPatients found to have AM according to the Chicago classification before surgical repair of PEH demonstrated similar symptomatic improvement compared with patients with NM. Selective motility disorders diagnosed by preoperative high-resolution manometry should not preclude surgical repair of giant PEHs.Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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