Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair

• Published in: Journal of the Society of Laparoendoscopic Surgeons Vol. 23; no. 2; p. e2019.00015
• Main Authors: Shea, Brian, Boyan, William, Decker, Jonathan, Almagno, Vincent, Binenbaum, Steven, Matharoo, Gurdeep, Squillaro, Anthony, Borao, Frank
• Format: Journal Article
• Language: English
• Published: United States Society of Laparoendoscopic Surgeons 01.04.2019
• Subjects: Aged; Aged, 80 and over; Elective Surgical Procedures; Female; Gastrectomy; Hernia, Hiatal - surgery; Herniorrhaphy; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Morbidity; Postoperative Complications - epidemiology; Recurrence; Retrospective Studies; repair; hiatal; elective; paraesophageal hernia; emergent; hiatus
• ISSN: 1086-8089; 1938-3797; 1938-3797
• DOI: 10.4293/JSLS.2019.00015

A feared complication of large paraesophageal hernias is incarceration necessitating emergent repair. According to previous studies, patients who require an emergent operation are subject to increased morbidity compared with patients undergoing elective operations. In this study, we detail patients who underwent hernia repair emergently and compare their outcomes with elective patients. A retrospective analysis was performed of the paraesophageal hernia repair operations between 2010 and 2016. Patients were divided into 2 groups: patients with hernias that were repaired electively and patients with hernias that were repaired emergently. Perioperative complications and follow-up data regarding morbidity, mortality, and recurrence were also recorded. A propensity analysis was used to compare emergent and elective groups. Thirty patients had hernias repaired emergently, and 199 patients underwent elective procedures. Patients undergoing emergent repair were more likely to have a type IV hernia, have a partial gastrectomy or gastrostomy tube insertion as part of their procedure, have a postoperative complication, and have a longer hospital stay. However, propensity analysis was used to demonstrate that when characteristics of the emergent and elective groups were matched, differences in these factors were no longer significant. Having an emergent operation did not increase a patient's risk for recurrence. Patients who had their hernias repaired emergently experienced complications at similar rates as those of elective patients with advanced age or comorbid conditions as demonstrated by the propensity analysis. The authors therefore recommend evaluation of all paraesophageal hernias for elective repair, especially in younger patients who are otherwise good operative candidates.