The contribution of hiatal hernia to severe gastroesophageal reflux disease in patients with gastroschisis

BackgroundA relationship between gastroschisis-associated gastroesophageal reflux (GER) and hiatal hernia (HH) has not been previously reported. In reviewing our experience with gastroschisis-related GER, we noted a surprising incidence of associated HH in patients requiring antireflux procedures.MethodsA single center retrospective chart review focused on GER in all gastroschisis patients repaired between January 1, 2000 and December 31, 2012 was performed.ResultsOf the 141 patients surviving initial gastroschisis repair and hospitalization, 16 (11.3%) were noted to have an associated HH (12 Type I, 3 Type II, 1 Type III) on upper gastrointestinal series for severe reflux. Ten of the 13 (76.9%) patients who required an antireflux procedure had an associated HH. The time to initiation of feeds was similar in all patients, 19 and 23 days. However, time to full feedings and discharge was delayed until a median of 80 and 96 days, respectively, in HH patients.ConclusionsThis study describes a high incidence of associated HH in gastroschisis patients. The presence of large associated HH correlated with severe GER, delayed feeding, requirement for antireflux surgery, and a prolonged hospital stay. Patients with gastroschisis and clinically severe GER should undergo early assessment for associated HH.