DIAPHRAGMATIC-HERNIA AND ASSOCIATED ANEMIA - RESPONSE TO SURGICAL-TREATMENT

From 1985 to 1993, 49 patients (35 women and 11 men) with diaphragmati c hernia and associated anemia underwent surgical repair. The median a ge was 64.5 years (range 24 to 84 gears), Hematologic and gastroentero logic evaluations revealed no other potential cause of bleeding. Each patient had a diaphragmatic hernia, The median time between the diagno sis of anemia and surgical repair mas 36 months (range 1 to 334 months ), Forty-five patients (91.8%) had received replacement therapy, inclu ding iron for 33 and blood transfusions for 32 (median 6 units; range 2 to 70 units), Forty-six patients (93.9%) had symptoms: heartburn in 28, early satiety with bloating in 19, regurgitation in 11, dysphagia in 7, and aspiration in 4, Preoperative upper gastrointestinal endosco pic evaluation demonstrated gastric erosions at the level of the hiatu s in 22 patients (44.9%), esophagitis in 7, stenosis in I, and Barrett 's disease in 1. An uncut CoIlis-Nissen fundoplication was performed i n 44 patients, Belsey fundoplication in 2, a cut Collis-Nissen fundopl ication, Nissen fundoplication, and Hill repair in I each, There was o ne operative death (2% mortality), Complications occurred in 18 patien ts (36.7%), Follow-up was complete and ranged from 4 to 103 months (me dian 63 months), Forty-five patients (91.8%) had resolution of their a nemia, Functional results, were excellent in 40 patients (81.6%), good in 2 (4.1%), fair in 4 (8.2%), and poor in 3 (6.1%). In most patients with diaphragmatic hernia and associated anemia refractory to medical treatment, surgical repair can result in successful resolution of the anemia.