A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach

Abstract

Strikingly, more than half of admissions for intrathoracic stomach were emergent. Emergent admissions had higher mortality, longer LOS, and higher cost than elective admissions. These data support consideration of early elective repair.

Should Elective Repair of Intrathoracic Stomach be Encouraged?

“…We recently reported an audit of the New York Statewide Planning and Research Cooperative System administrative database including nearly 5,000 admissions for an intrathoracic stomach over 5 years (2002)(2003)(2004)(2005)(2006). 17 With or without surgical intervention, emergent admissions had a higher mortality, longer length of stay, and higher hospital costs when compared to elective admissions. When assessing admissions with operative repair only, emergent operative admissions had nearly 5-fold higher mortality (5.1% vs. 1.1%) and doubled length of stay and hospital costs compared to elective operative admissions.…”

Long-term Quality of Life and Risk Factors for Recurrence After Laparoscopic Repair of Paraesophageal Hernia

“…Similar findings were demonstrated by Ponsky et al 16 All of our patients underwent complete esophageal mobilization and sac excision, but our study did not demonstrate any significant difference in recurrence rates between patients who did or did not undergo gastropexy (P = .21). doplication, cruroplasty, and posterior onlay of a polyester mesh (Parietex; Covidien) if a hiatus with a surface area of 5.60 cm 2 or greater was present. The authors reported no significant complications with the use of mesh and concluded that recurrence was more likely with increased hiatal surface area.…”

New Surgical Approach for Giant Paraesophageal Hernia Repair: Closure of the Esophageal Hiatus Anteriorly Using the Left Triangular Ligament

“…Operative repair is recommended to treat associated symptoms and conditions such as gastroesophageal reflux disease (GERD), postprandial shortness of breath, gastric outlet obstruction, postprandial pain, erosive esophagitis or Cameron's erosions that may result in anemia, and to prevent subsequent enlargement of the hernia and a more challenging repair in the future [7,8,9,10]. Early repair is also recommended to prevent gastric volvulus or strangulation, as emergent PEH repair is associated with a 5-20 times increase in morbidity and mortality compared to elective repair [11]. …”