Non-Elective Paraesophageal Hernia Repair Portends Worse Outcomes in Comparable Patients: a Propensity-Adjusted Analysis

Tam, Vernissia; Luketich, James D.; Winger, Daniel G.; Sarkaria, Inderpal S.; Levy, Ryan M.; Christie, Neil A.; Awais, Omar; Shende, Manisha; Nason, Katie S.

doi:10.1007/s11605-016-3231-y

Cited by 26 publications

(14 citation statements)

References 23 publications

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“…The authors analyzed 980 patients at a single institution, and found that even when accounting for baseline patient characteristics, emergent repair was associated with worse outcomes when compared with elective repair. 24 Similarly, a study by Jassim et al surveyed a nationwide inpatient sample, and found that emergent repair was associated with higher rates of morbidity and mortality when compared with elective patients. 7…”

Section: Discussionmentioning

confidence: 99%

Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair

Shea

Boyan

Decker

et al. 2019

JSLS

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Background and Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.

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Section: Discussionmentioning

confidence: 99%

Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair

Shea

Boyan

Decker

et al. 2019

JSLS

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“…The latter is justified from the mortality rate that emergent repair poses. Another very interesting study, claimed that 'non-elective repair was independently associated with 1.7 times increased odds of major adverse events and trended toward an increase of 2.7 times for odds of mortality compared to elective repair, after accounting for age and comorbid index score (23). Emergency repair of a large paraesophageal HH is associated with increased morbidity in comparison with elective surgery, in a study of the American College of Surgeons National Surgical Quality Improvement Program, including 383 patients (16% versus 1.6%) (22).…”

Section: Resultsmentioning

confidence: 99%

Large Paraesophageal Hiatus Hernia: Is Surgery Mandatory?

Dellaportas¹,

Papaconstantinou²,

Nastos³

et al. 2018

chr

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Purpose/Aim: Paraesophageal hiatus hernias are seldom found, however the incidence is increasing accounting for 5-10% of all hiatal hernias. The aim of this review is to emphasize controversies in clinical presentation, essential workup investigations and highlight non-surgical and surgical management options. Materials and Methods: A PubMed literature search using the keywords 'large or giant paraesophageal hernia', 'hiatus or hiatal hernia', 'laparoscopic surgery', 'antireflux surgery', 'mesh', 'gastric volvulus' and 'diaphragmatic hernia' published between 1998 until 2017 was conducted. Results: Presenting symptoms are non-specific and can be erroneously attributed to various more common medical conditions. Significant complications as gastric volvulus and stomach necrosis, may occur and the obscured clinical presentation can be confusing for the clinician. Management options in the elective setting are controversial, and surgical repair cannot be easily justified for a minimally symptomatic condition, especially in an elderly and perhaps frail patient. However, in the era of laparoscopic surgery around the hiatus, reduced operative stress makes surgical repair appealing in the elective setting. Surgical matters as the adjunct of an antireflux procedure or not, the use of prosthetic mesh to reinforce the hiatus, gastropexy and the clinical importance of radiological or endoscopic recurrence are still under debate. Conclusions: The laparoscopic treatment of paraesophageal hiatus hernias is effective with low morbidity rates, offered in symptomatic patients and good operative risk asymptomatic individuals. More studies are needed to assess improvement suggestions, as the use of prosthetic mesh or gastropexy, regarding complications and recurrence risks.

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“…Acute complications in PEH are surgical emergency; both laparoscopic and open approach have been used and debate also exists as to which approach is preferable. Patients undergoing emergent surgery for hiatal hernia repair have more adverse prognostic factors and more major complications (38 versus 18%; p < 0.001) and deaths (8 versus 1%; p < 0.001) [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Jejunal Diverticular Perforation Causing Small Bowel Obstruction in a Type 4 Hiatal Hernia: A Rare Case Report of a Nonagenarian Patient and Review of Relevant Literature

Biswas

Gogna

Patel

2017

Case Reports in Surgery

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Type IV paraesophageal hernia (PEH) is very rare and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a case of a 90-year-old male patient who presented at our emergency department complaining of epigastric pain that he had experienced over the past few hours and getting progressively worse. On the day after admission, his pain became severe. Chest radiography revealed an intrathoracic intestinal gas bubble; emergency exploratory laparotomy identified a type IV PEH with herniation of only the jejunum with perforated diverticula on mesenteric side through a hiatal defect into mediastinum. There are a few published cases of small bowel herniation into the thoracic cavity in the literature. Our patient represents a rare case of an individual diagnosed with type IV PEH with herniation of jejunum with perforated diverticula.

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Non-Elective Paraesophageal Hernia Repair Portends Worse Outcomes in Comparable Patients: a Propensity-Adjusted Analysis

Cited by 26 publications

References 23 publications

Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair

Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair

Large Paraesophageal Hiatus Hernia: Is Surgery Mandatory?

Jejunal Diverticular Perforation Causing Small Bowel Obstruction in a Type 4 Hiatal Hernia: A Rare Case Report of a Nonagenarian Patient and Review of Relevant Literature

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