Primary versus redo paraesophageal hiatal hernia repair: a comparative analysis of operative and quality of life outcomes

Introduction: We compared patient outcomes after initial versus redo paraesophageal hernia (PEH) repair at two high-volume GI surgery centers. Materials and methods: Retrospective review analyzed one-year outcomes after initial versus redo elective laparoscopic PEH repair, including wound/non-wound-related complications and quality of life benefits as measured by four validated instruments: reflux symptom index, gastroesophageal reflux disease health-related, laryngopharyngeal reflux, and swallowing scales. Results: Three hundred and seventeen patients (271 initial and 46 redo) underwent laparoscopic PEH repair. Groups differed with respect to age (64.6 vs. 60.2 years, p = 0.027), but were comparable in gender (71.2 vs. 67.4% female, p = 0.596), BMI (29.0 vs. 27.6 kg/m², p = 0.100), and ASA score (2.3 vs. 2.3 p = 0.666). Redo surgery was more complex with longer mean operative times (112.2 vs. 139.1 min, p < 0.001). Groups did not statistically differ with respect to 30-day wound (0.7 vs. 2.2%, p = 0.363) and non-wound (6.0 vs. 8.7%, p = 0.511)-related complications. After one year of follow-up, QOL analysis revealed that initial versus redo groups significantly benefited from operative intervention. Conclusions: Although redo PEH repairs are more complex, patients enjoy equivalent operative outcomes and quality of life benefits compared to initial surgery lending support to the significance of surgeon experience and high-volume centers in optimizing outcomes.