Calidad de vida y resultados a largo plazo de las reintervenciones efectuadas por laparoscopia tras cirugía del hiato esofágico

Mesh-related complications in paraoesophageal repair: a systematic review

BACKGROUND

Paraoesophageal hernias (PEH) have a high recurrence rate, prompting surgeons to consider the use of mesh reinforcement of the hiatus. The risks and benefits of mesh augmentation in PEH repair are debated. Mesh-related complications including migration and erosion are considered in this publication.

DESIGN

A systematic literature review of articles published between 1970 and 2019 in Medline, OVID, Embase, and Springer database was conducted, identifying case reports, case series and observational studies of PEH repair reporting mesh-related complications.

RESULTS

Thirty-five case reports/series of 74 patients and 20 observational studies reporting 75 of 4200 patients with mesh complications have been included. The incidence of mesh-related erosions in this study is 0.035%. PTFE, ePTFE, composite and synthetic meshes were frequently associated with mesh erosion requiring intervention. Complete erosions are often managed endoscopically while partial erosions may require surgery and resection of the oesophagus and/or stomach.

CONCLUSIONS

Mesh-related complication is rare with dysphagia a common presenting feature. Mesh erosion is associated with synthetic mesh more frequently in the reported literature. A mesh registry with long-term longitudinal data would help in understanding the true incidence of mesh-related complications.

Quality of life in patients operated on for digestive neoplasia: a prospective study

AIM

The aim of this study was to evaluate the quality of life in patients having surgery for a digestive neoplasm and to monitor how the patient's perception evolves during the first 6 months after surgery.

METHOD

A prospective study was carried out on the pre and postoperative quality of life of patients undergoing surgery for a digestive system neoplasm between May 2009 and December 2010. Patients were asked to complete the Short Form (36) Health Survey questionnaire (SF-36; spanish version 1.4).

RESULTS

The study included 80 patients. At 1 month after surgery there was a statistically significant improvement in some domains of the SF-36. At 6 months, a statistically significant improvement was seen in physical functioning, social functioning, mental health and in the two physical and mental domains. We also found statistically significant differences, with women having a worse quality of life.

CONCLUSION

Comparison of quality of life before and 6 months after surgical intervention showed improvement in both the psychological and the physical elements. This can be attributed to the fact that the patients have had time to recover from the surgery.

Disease-specific health-related quality of life in patients with esophageal achalasia before and after therapy

BACKGROUND

To evaluate disease-specific health-related quality of life (HRQoL) in patients with symptomatic esophageal achalasia before and after therapy.

METHODS

Symptoms and disease-specific HRQoL were evaluated before and 3 months after therapy. Therapy selection, either dilatation or myotomy, depended exclusively on the opinion of the physician on charge of the patient. Symptom severity was graded from 0 to 3, using a scoring system. A disease-specific questionnaire for achalasia developed and validated in Spanish language with 18 items and four subscales (AE-18) was used to evaluate HRQoL. Changes after therapy in HRQoL and its association with clinical improvement were analyzed.

KEY RESULTS

Sixty-five patients were prospectively included in eight hospitals in Spain. Of them, 47 were treated with dilatation, and 18 with laparoscopic Heller myotomy. After therapy, AE-18 global and subscales scores improved significantly. Changes in HRQoL were associated with improvement in symptoms. An important improvement in symptoms (>or=50%) was needed to obtain a minimal clinically important improvement (>or=20%) in HRQoL.

CONCLUSIONS & INFERENCES

Disease-specific HRQoL improves in patients with symptomatic achalasia after therapy with dilatation or myotomy. The degree of improvement of HRQoL depends on the degree of improvement of esophageal symptoms.