Quality of Life Following Laparoscopic Hiatal Hernia Repair and Anterior 180° Partial Fundoplication for Symptomatic Sliding Hiatal Hernia

Background

Laparoscopic hiatal hernia repair (LHHR) is the treatment of choice for symptomatic sliding hiatal hernia. This study evaluates health-related quality of life (HRQOL) outcomes following LHHR with anterior 180° partial fundoplication.

Methods

Forty consecutive patients underwent LHHR with anterior 180° partial fundoplication between June 2020 and December 2022. Patients were included based on one of the following criteria: persistent symptoms despite optimal medical therapy (55%), preference for a surgical solution over lifelong medication (37.5%), or complications including reflux oesophagitis/Barrett's esophagus (7.5%). HRQOL was assessed using the SF-36 questionnaire preoperatively and at 1, 6, and 12 months postoperatively.

Results

Significant improvements were observed in physical functioning (66.3 ± 24.7 to 95.6 ± 7.7, p < 0.001), bodily pain (38.1 ± 28.1 to 79.2 ± 18.6, p < 0.001), general health (37.7 ± 16.2 to 66.1 ± 23.6, p < 0.001), social function (62.5 ± 23.7 to 85.6 ± 16.1, p < 0.001), and mental health (68.2 ± 21.4 to 83.7 ± 12.5, p < 0.001) at 12 months. Role limitations due to physical health improved gradually, becoming significant at 12 months (60.0 ± 45.6 to 86.9 ± 16.8, p < 0.001). Early improvements in vitality (p = 0.02) and role limitations due to emotional health (p = 0.331) showed some decline by 12 months. The median hospital stay was 3 days, with no major complications. At 1 year, 72.5% of patients were medication-free, while anatomical recurrence was observed in 7.5%. Patients with recurrence showed lower physical functioning (82.3 vs. 96.8, p = 0.02) and bodily pain scores (65.7 vs. 80.5, p = 0.04) but still demonstrated significant improvement from baseline. Body mass index, education level, age, and defect area did not influence outcomes (all p > 0.05).

Conclusion

LHHR with anterior 180° partial fundoplication significantly improves quality of life across multiple domains, with sustained benefits at 12 months post-surgery, particularly in physical function, pain, and social functioning. Most domains reached or surpassed population norms by 12 months, establishing this approach as an effective treatment for symptomatic sliding hiatal hernia.