148: laparoscopic fundoplication for para-esophageal hernia repair improves respiratory function in patients presenting with dyspnea: a prospective cohort study

Abstract Background and aim Dyspnea in patients with a para-esophageal hernia (PEH) occurs in 7 to 32% of cases and is very disabling, especially in the elderly and its origin is poorly defined. The present study aims to assess the impact of laparoscopic fundoplication (LF) on dyspnea and respiratory function. Methods Dyspnea assessment through dyspnea visual analogic scale (DVAS) and modified medical research council score and pulmonary function test (PFT) with plethysmography were performed before and 2 months after LF in all consecutive patients undergoing LF for PEH from January 2019 to May 2021. Results All 43 patients included had pre-and postoperative dyspnea assessments and pulmonary PFT. Patients’ median age was 70 years (range 63–73.5 years), 37 (86%) were women, the median percentage of the intrathoracic stomach was 59.9% (range 44.2%–83.0%), the median length of hospital stay was 3 days (range 3–4 days). After surgery, the DVAS decreased statistically significantly (5.6 [4.7–6.7] vs 3.0 [2.3–4.4] P < 0.001), and 37 (86%) patients had a clinically significant decrease inMMRC. Absolute forced expiratory volume in one second (FEV1), total lung capacity, and forced vital capacity also statistically significantly increased after surgery respectively on average by +11.2% (SD 17.9), +5.0% (SD 13.9), and + 10.7% (SD 14.6). Subgroup analysis highlighted patients with low preoperative FEV1 were more susceptible to improve it. No correlation was identified between improvement in dyspnea and FEV1. Also, no correlation was identified between the percentage of intrathoracic stomach and dyspnea or PFT parameters improvement. Conclusion PEH repair improves dyspnea and FEV1 in a statistically significant manner in a population of patients presenting with dyspnea. Patients with a low preoperative FEV1 are more likely to improve it after LF.