Urgent laparoscopic repair of acutely symptomatic PEH is safe and effective

Parker, David M.; Rambhajan, Amrit; Johanson, Katherine; Ibele, Anna; Gabrielsen, Jon; Petrick, Anthony

doi:10.1007/s00464-013-3064-7

Cited by 20 publications

(11 citation statements)

References 19 publications

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“…Fundoplication is part of the typical laparoscopic PEH repair, and many previous studies have demonstrated how safe and practical this type of repair is in treating PEHs [4]. Overall, elective laparoscopic PEH repair has been shown to be associated with decreased recurrence rates, morbidity, length of hospital stay, and need for ICU admission compared to an open approach [5]. In elective surgeries, laparoscopic repair with fundoplication is currently the preferred procedure.…”

Section: Introductionmentioning

confidence: 98%

Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

et al. 2015

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We demonstrate that laparoscopic PEH repair has become accepted in emergent cases. Open PEH repair is often reserved for emergent surgeries and less commonly includes an AR procedure. Laparoscopy with an AR procedure is clearly the standard of care in elective surgery. The decision to perform an open or laparoscopic surgery, with or without adjunctive techniques, may be based more on the physician's comfort with laparoscopic surgery and surgical practices than the patient's condition. Long-term follow-up studies are needed to determine the functional outcomes of these strategies.

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Section: Introductionmentioning

confidence: 98%

Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

et al. 2015

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“…4 Because acute complications of PEH, including gastric volvulus and strangulation, are associated with mortality rates as high as 16%, 3 equipoise remains regarding the safety of watchful waiting for symptomatic patients, with many surgeons continuing to advocate for elective intervention. 2,3 …”

Section: Introductionmentioning

confidence: 99%

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

Tam

Luketich

Winger

et al. 2017

Journal of Gastrointestinal Surgery

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Introduction Patients undergoing non-elective paraesophageal hernia repair (PEHR) have worse perioperative outcomes. Because they are usually older and sicker, however, these patients may be more prone to adverse events, independent of surgical urgency. Our study aimed to determine whether non-elective PEHR is associated with differential postoperative outcome compared to elective repair, using propensity-score weighting. Methods We abstracted data for patients undergoing PEHR (n=924; non-elective n=171 [19%]; 1997-2010). Using boosted regression, we generated a propensity-weighted dataset. Odds of 30-day/in-hospital mortality and major complications after non-elective surgery were determined. Results Patients undergoing non-elective repair were significantly older, had more adverse prognostic factors and significantly more major complications (38% vs 18%; p<0.001) and death (8% vs 1%; p<0.001). After propensity-weighting, median absolute percentage bias across 28 propensity-score variables improved from 19% (significant imbalance) to 5.6% (well-balanced). After adjusting propensity-weighted data for age and comorbidity score, odds of major complications were still nearly 2 times greater (OR 1.67, CI 1.07-2.61) and mortality nearly 3 times greater (OR 2.74, CI 0.93-8.1) than for elective repair. Conclusions Even after balancing significant differences in baseline characteristics, non-elective PEHR was associated with worse outcomes than elective repair. Symptomatic patients should be referred for elective repair by experienced surgeons.

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“…pacientes intervenidos tuvieron rangos de edades mayores con múltiples comorbilidades asociadas que influyen, por supuesto, en términos de estancia hospitalaria y morbilidad (34).…”

Section: Consideraciones Técnicas Y Recomendaciones De Los Autoresunclassified

“…Estos resultados contrastan con los reportados por Parker y colaboradores, donde se presentó una mayor estancia hospitalaria y comorbilidades asociadas en pacientes ancianos e intervenidos agudamente (34). Nosotros consideramos que los pacientes ancianos asintomáticos o con sintomatología leve y sin comorbilidades relevantes deben ser evaluados para definir la posibilidad de cirugía.…”

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Hernia hiatal recidivante: la visión del cirujano. Revisión de la literatura

Arévalo¹,

Luna²,

Luna-Jaspe³

et al. 2016

Rev. Colomb. Gastroenterol.

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ResumenLas hernias hiatales recidivantes constituyen una patología común que generan un reto diagnóstico y terapéu-tico para cirujanos y gastroenterólogos. Generalmente se presentan de forma asintomática o con síntomas atípicos y se asocian a factores fisiológicos, propios del paciente y de la técnica quirúrgica. Su tratamiento es complejo y dependiendo de la causa de los síntomas pueden requerir manejo médico o quirúrgico. En este artículo, se pretenden definir pautas para la identificación y manejo de esta patología, así como establecer claves para el tratamiento desde un enfoque quirúrgico. Palabras claveHernia hiatal, hernia hiatal recidivante, laparoscopia. AbstractRecurrent hiatal hernias are a common pathology that generate a diagnostic and therapeutic challenge for surgeons and gastroenterologists. They are generally asymptomatic or present with atypical symptoms and are associated with the patient's own physiological factors and the surgical technique. Treatment is complex and, depending on the cause of the symptoms, will require either medical or surgical management. This article starts from a surgical approach to define guidelines for identification and management of this condition and to establish keys to treatment. KeywordsHiatal hernia, recurrent hiatal hernia, laparoscopy Revisión de tema INTRODUCCIÓNLa cirugía para el tratamiento de las hernias hiatales constituye un reto para el cirujano, que requiere un amplio conocimiento de la anatomía de la unión esofagogástrica y del hiato esofágico. El reparo laparoscópico es el estándar de tratamiento, pero demanda una amplia disección esofágica, cierre adecuado del hiato y un mecanismo antirreflujo; los factores fisiológicos asociados a condiciones propias del paciente, técnica quirúrgica y experiencia del cirujano juegan un papel importante en la alta tasa de recidivas. El tratamiento de las hernias recidivantes genera un desafío y comprende procedimientos con múltiples complicaciones que pueden terminar en perforaciones esofágicas o gástricas e incluso requerir procedimientos de mayor complejidad como la esofagogastrectomía. En este artículo se pretende definir pautas para identificar y manejar esta patología, así como establecer opciones para su tratamiento a partir del enfoque de cirujanos laparoscopistas y gastrointestinales. ESTRATEGIAS DE BÚSQUEDASe realizó una revisión bibliográfica en Infomed (Scielo, MEDLINE, LILACS, Hinari, Pubmed, Pubmed Central

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Urgent laparoscopic repair of acutely symptomatic PEH is safe and effective

Cited by 20 publications

References 19 publications

Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

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

Hernia hiatal recidivante: la visión del cirujano. Revisión de la literatura

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