E2333. Decreased Size of Hiatal Hernias Following Percutaneous Gastrostomy Tubes: An Unintended Benefit?
  1. Shan Hansra; UC Davis
  2. Arjun Vij; UC Davis
  3. Michael Larson; UC Davis
Patients with type II hiatal hernias (paraesophageal) who are symptomatic should undergo surgical repair, especially those with signs of volvulus or acute obstruction. Standard surgical repair involves dissection of the hernia sac, reduction of the esophagus into the abdomen, followed by hiatus repair. Paraesophageal hernia surgery is a technically challenging surgery which can last several hours and carries a significant risk of comorbidities. Several studies have looked at expediting surgery by performing hernia reduction and gastropexy, without hiatus repair. In some cases, up to three gastrostomy tubes (G-tube) have been used. To our knowledge, no studies have looked at the effect of gastropexy alone on hiatal hernias. We hypothesized percutaneous G-tube without other surgical intervention has the potential to decrease the size of hiatal hernias.

Materials and Methods:
We used Nuance mPower™ Clinical Analytics to perform a sequential search to find all patients at a tertiary care medical center who had a CT with mention of a “hiatal hernia” before having a G-tube placed over the 6-year period between January 1, 2015 and December 31, 2020. We excluded 18 patients with invalid studies (e.g., failed G-tube placement), 36 patients with no follow-up CT, and 6 patients with extremely small hiatuses. Our final sample consisted of 37 patients. The hiatus was measured at the widest point between the sharp bifurcation of the right crus and the junction of the left and right crura. Measurements were made by two reviewers. Hiatus sizes were compared on CTs done before G-tube placement with CTs done after G-tube placement.

The results of the paired-t test indicated that there was a significant difference in hiatus width between the before G-tube group (M = 18.4 mm, SD = 6 mm) and the after G-tube group (M = 16.7, SD = 6.3 mm), t (36) = 3.1, p = .004.

In elderly patients with comorbidities, standard surgical repair of hiatal hernias carries significant risk and several techniques have been described to expedite surgery using gastropexy. This is the first study to assess the effect of G-tubes alone without other intervention. There is a significant reduction in hiatus size following percutaneous gastrostomy. By decreasing the size of hiatal hernias and providing stomach fixation, G-tubes may play a role in reducing hernia symptoms and reducing the risk of acute hernia complications. Further research is needed to assess hernia-related clinical outcomes in patients who have underwent percutaneous gastrostomy.