Outcomes after revisional surgery for paraesophageal hernias at a high-volume tertiary care center
Background Although recurrences after repair of giant paraesophageal hernias (PEH) are common, revisional procedures are challenging and associated with higher complication rates than primary repair. Therefore, repair of recurrent PEH is often avoided except in symptomatic patients. Data describing...
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| description | Background
Although recurrences after repair of giant paraesophageal hernias (PEH) are common, revisional procedures are challenging and associated with higher complication rates than primary repair. Therefore, repair of recurrent PEH is often avoided except in symptomatic patients. Data describing operative outcomes in these infrequent cases is lacking. Therefore, this study aimed to report and compare peri-operative outcomes of revisional PEH repair to similar patients undergoing primary surgery.
Methods
A single-institution, retrospective cohort study was conducted on all adult patients undergoing primary repair of Type II–IV PEH and any revisional surgery for recurrent hiatal hernia after previous primary PEH repair (2012–2019). Patient and operative characteristics and post-operative outcomes were extracted from medical records. Patients were grouped into revisional (rPEH) and primary repair (pPEH). Coarsened exact matching was performed to create balanced cohorts.
Results
A total of 347 cases were identified. The matched cohort included 234 patients (rPEH: 46, pPEH: 188). Patient sex and comorbidities were well balanced, while those who underwent revisions were younger (64 ± 13 vs. 69 ± 11 years;
p
= 0.01). Median time between primary and rPEH was 40[17–121] months. Incidence of emergency repair were similar among groups (rPEH: 9(15%), pPEH: 14(8%);
p
= 0.10). All revisional cases commenced laparoscopically with 7(15%) requiring conversion to open. The conversion rate was higher for rPEH than primary surgery (7(15%) vs. 3(2%);
p
|
| doi_str_mv | 10.1007/s00464-024-11325-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3119190919</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3138983501</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-90c7123382437061e3878220cd16719d39929b61a2b2df193160209b9b80177e3</originalsourceid><addsrcrecordid>eNp9kU9r3DAQxUVpaDZ_vkAPRdBLL0pmNLZlHUtI2kAgl-QsZO9418G2tpIdyLevNpu2kEMPYkDze2-YeUJ8RrhAAHOZAIqqUKALhUi6VOUHscKCtNIa649iBZZAaWOLY3GS0hNk3mL5SRyTLYjK2qxEc7_MbRg5Sd_NHGXk5z71YfKDTEvccHyRXYhy56PnFHZbv-Hc2nKcep81s_Ry22-26jkMy8gyW8y9z6LWR5YtT_njTBx1fkh8_lZPxePN9cPVT3V3_-P26vudanVZzcpCa1AT1bogAxUy1abWGto1VgbtmqzVtqnQ60avO7SEFWiwjW1qQGOYTsW3g-8uhl8Lp9mNfWp5GPzEYUmOEC1ayC-jX9-hT2GJeek9RbWtqQTMlD5QbQwpRe7cLvZj3s4huH0C7pCAywm41wRcmUVf3qyXZuT1X8mfk2eADkDKrSlf-N_s_9j-BrpFj2k</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3138983501</pqid></control><display><type>article</type><title>Outcomes after revisional surgery for paraesophageal hernias at a high-volume tertiary care center</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Kammili, Anitha ; Trépanier, Maude ; Cools-Lartigue, Jonathan ; Ferri, Lorenzo E. ; Mueller, Carmen L.</creator><creatorcontrib>Kammili, Anitha ; Trépanier, Maude ; Cools-Lartigue, Jonathan ; Ferri, Lorenzo E. ; Mueller, Carmen L.</creatorcontrib><description>Background
Although recurrences after repair of giant paraesophageal hernias (PEH) are common, revisional procedures are challenging and associated with higher complication rates than primary repair. Therefore, repair of recurrent PEH is often avoided except in symptomatic patients. Data describing operative outcomes in these infrequent cases is lacking. Therefore, this study aimed to report and compare peri-operative outcomes of revisional PEH repair to similar patients undergoing primary surgery.
Methods
A single-institution, retrospective cohort study was conducted on all adult patients undergoing primary repair of Type II–IV PEH and any revisional surgery for recurrent hiatal hernia after previous primary PEH repair (2012–2019). Patient and operative characteristics and post-operative outcomes were extracted from medical records. Patients were grouped into revisional (rPEH) and primary repair (pPEH). Coarsened exact matching was performed to create balanced cohorts.
Results
A total of 347 cases were identified. The matched cohort included 234 patients (rPEH: 46, pPEH: 188). Patient sex and comorbidities were well balanced, while those who underwent revisions were younger (64 ± 13 vs. 69 ± 11 years;
p
= 0.01). Median time between primary and rPEH was 40[17–121] months. Incidence of emergency repair were similar among groups (rPEH: 9(15%), pPEH: 14(8%);
p
= 0.10). All revisional cases commenced laparoscopically with 7(15%) requiring conversion to open. The conversion rate was higher for rPEH than primary surgery (7(15%) vs. 3(2%);
p
< 0.01), with the most common reasons being adhesions and gastric fundus injury. Intra-operative complications occurred in 12(26%) revisional cases, of which 58% were gastric fundus injuries. Median length of stay was longer for rPEH than pPEH (2[1–5] vs. 1[1–2] day;
p
= 0.02). Incidence of severe complications (rPEH: 5(11%), pPEH: 11(6%);
p
= 0.23) and reoperations (rPEH: 2(4%), pPEH: 7(4%);
p
= 0.84) were similar between groups. There were no peri-operative deaths.
Conclusion
In a high-volume tertiary care center, repair of recurrent giant paraesophageal hernias can be performed successfully laparoscopically in the majority of cases with acceptable morbidity and peri-operative outcomes in comparison to primary surgery.</description><identifier>ISSN: 0930-2794</identifier><identifier>ISSN: 1432-2218</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-024-11325-5</identifier><identifier>PMID: 39433587</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Aged ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Hernia, Hiatal - surgery ; Hernias ; Herniorrhaphy - methods ; Hospitals, High-Volume ; Humans ; Laparoscopy - methods ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Proctology ; Recurrence ; Reoperation - statistics & numerical data ; Retrospective Studies ; Surgery ; Tertiary Care Centers ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2024-12, Vol.38 (12), p.7361-7365</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024 Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>Copyright Springer Nature B.V. Dec 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-90c7123382437061e3878220cd16719d39929b61a2b2df193160209b9b80177e3</cites><orcidid>0000-0003-4909-205X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-024-11325-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-024-11325-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39433587$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kammili, Anitha</creatorcontrib><creatorcontrib>Trépanier, Maude</creatorcontrib><creatorcontrib>Cools-Lartigue, Jonathan</creatorcontrib><creatorcontrib>Ferri, Lorenzo E.</creatorcontrib><creatorcontrib>Mueller, Carmen L.</creatorcontrib><title>Outcomes after revisional surgery for paraesophageal hernias at a high-volume tertiary care center</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Although recurrences after repair of giant paraesophageal hernias (PEH) are common, revisional procedures are challenging and associated with higher complication rates than primary repair. Therefore, repair of recurrent PEH is often avoided except in symptomatic patients. Data describing operative outcomes in these infrequent cases is lacking. Therefore, this study aimed to report and compare peri-operative outcomes of revisional PEH repair to similar patients undergoing primary surgery.
Methods
A single-institution, retrospective cohort study was conducted on all adult patients undergoing primary repair of Type II–IV PEH and any revisional surgery for recurrent hiatal hernia after previous primary PEH repair (2012–2019). Patient and operative characteristics and post-operative outcomes were extracted from medical records. Patients were grouped into revisional (rPEH) and primary repair (pPEH). Coarsened exact matching was performed to create balanced cohorts.
Results
A total of 347 cases were identified. The matched cohort included 234 patients (rPEH: 46, pPEH: 188). Patient sex and comorbidities were well balanced, while those who underwent revisions were younger (64 ± 13 vs. 69 ± 11 years;
p
= 0.01). Median time between primary and rPEH was 40[17–121] months. Incidence of emergency repair were similar among groups (rPEH: 9(15%), pPEH: 14(8%);
p
= 0.10). All revisional cases commenced laparoscopically with 7(15%) requiring conversion to open. The conversion rate was higher for rPEH than primary surgery (7(15%) vs. 3(2%);
p
< 0.01), with the most common reasons being adhesions and gastric fundus injury. Intra-operative complications occurred in 12(26%) revisional cases, of which 58% were gastric fundus injuries. Median length of stay was longer for rPEH than pPEH (2[1–5] vs. 1[1–2] day;
p
= 0.02). Incidence of severe complications (rPEH: 5(11%), pPEH: 11(6%);
p
= 0.23) and reoperations (rPEH: 2(4%), pPEH: 7(4%);
p
= 0.84) were similar between groups. There were no peri-operative deaths.
Conclusion
In a high-volume tertiary care center, repair of recurrent giant paraesophageal hernias can be performed successfully laparoscopically in the majority of cases with acceptable morbidity and peri-operative outcomes in comparison to primary surgery.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernia, Hiatal - surgery</subject><subject>Hernias</subject><subject>Herniorrhaphy - methods</subject><subject>Hospitals, High-Volume</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Proctology</subject><subject>Recurrence</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Tertiary Care Centers</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9r3DAQxUVpaDZ_vkAPRdBLL0pmNLZlHUtI2kAgl-QsZO9418G2tpIdyLevNpu2kEMPYkDze2-YeUJ8RrhAAHOZAIqqUKALhUi6VOUHscKCtNIa649iBZZAaWOLY3GS0hNk3mL5SRyTLYjK2qxEc7_MbRg5Sd_NHGXk5z71YfKDTEvccHyRXYhy56PnFHZbv-Hc2nKcep81s_Ry22-26jkMy8gyW8y9z6LWR5YtT_njTBx1fkh8_lZPxePN9cPVT3V3_-P26vudanVZzcpCa1AT1bogAxUy1abWGto1VgbtmqzVtqnQ60avO7SEFWiwjW1qQGOYTsW3g-8uhl8Lp9mNfWp5GPzEYUmOEC1ayC-jX9-hT2GJeek9RbWtqQTMlD5QbQwpRe7cLvZj3s4huH0C7pCAywm41wRcmUVf3qyXZuT1X8mfk2eADkDKrSlf-N_s_9j-BrpFj2k</recordid><startdate>20241201</startdate><enddate>20241201</enddate><creator>Kammili, Anitha</creator><creator>Trépanier, Maude</creator><creator>Cools-Lartigue, Jonathan</creator><creator>Ferri, Lorenzo E.</creator><creator>Mueller, Carmen L.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4909-205X</orcidid></search><sort><creationdate>20241201</creationdate><title>Outcomes after revisional surgery for paraesophageal hernias at a high-volume tertiary care center</title><author>Kammili, Anitha ; Trépanier, Maude ; Cools-Lartigue, Jonathan ; Ferri, Lorenzo E. ; Mueller, Carmen L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-90c7123382437061e3878220cd16719d39929b61a2b2df193160209b9b80177e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernia, Hiatal - surgery</topic><topic>Hernias</topic><topic>Herniorrhaphy - methods</topic><topic>Hospitals, High-Volume</topic><topic>Humans</topic><topic>Laparoscopy - methods</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Proctology</topic><topic>Recurrence</topic><topic>Reoperation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Tertiary Care Centers</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kammili, Anitha</creatorcontrib><creatorcontrib>Trépanier, Maude</creatorcontrib><creatorcontrib>Cools-Lartigue, Jonathan</creatorcontrib><creatorcontrib>Ferri, Lorenzo E.</creatorcontrib><creatorcontrib>Mueller, Carmen L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kammili, Anitha</au><au>Trépanier, Maude</au><au>Cools-Lartigue, Jonathan</au><au>Ferri, Lorenzo E.</au><au>Mueller, Carmen L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes after revisional surgery for paraesophageal hernias at a high-volume tertiary care center</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2024-12-01</date><risdate>2024</risdate><volume>38</volume><issue>12</issue><spage>7361</spage><epage>7365</epage><pages>7361-7365</pages><issn>0930-2794</issn><issn>1432-2218</issn><eissn>1432-2218</eissn><abstract>Background
Although recurrences after repair of giant paraesophageal hernias (PEH) are common, revisional procedures are challenging and associated with higher complication rates than primary repair. Therefore, repair of recurrent PEH is often avoided except in symptomatic patients. Data describing operative outcomes in these infrequent cases is lacking. Therefore, this study aimed to report and compare peri-operative outcomes of revisional PEH repair to similar patients undergoing primary surgery.
Methods
A single-institution, retrospective cohort study was conducted on all adult patients undergoing primary repair of Type II–IV PEH and any revisional surgery for recurrent hiatal hernia after previous primary PEH repair (2012–2019). Patient and operative characteristics and post-operative outcomes were extracted from medical records. Patients were grouped into revisional (rPEH) and primary repair (pPEH). Coarsened exact matching was performed to create balanced cohorts.
Results
A total of 347 cases were identified. The matched cohort included 234 patients (rPEH: 46, pPEH: 188). Patient sex and comorbidities were well balanced, while those who underwent revisions were younger (64 ± 13 vs. 69 ± 11 years;
p
= 0.01). Median time between primary and rPEH was 40[17–121] months. Incidence of emergency repair were similar among groups (rPEH: 9(15%), pPEH: 14(8%);
p
= 0.10). All revisional cases commenced laparoscopically with 7(15%) requiring conversion to open. The conversion rate was higher for rPEH than primary surgery (7(15%) vs. 3(2%);
p
< 0.01), with the most common reasons being adhesions and gastric fundus injury. Intra-operative complications occurred in 12(26%) revisional cases, of which 58% were gastric fundus injuries. Median length of stay was longer for rPEH than pPEH (2[1–5] vs. 1[1–2] day;
p
= 0.02). Incidence of severe complications (rPEH: 5(11%), pPEH: 11(6%);
p
= 0.23) and reoperations (rPEH: 2(4%), pPEH: 7(4%);
p
= 0.84) were similar between groups. There were no peri-operative deaths.
Conclusion
In a high-volume tertiary care center, repair of recurrent giant paraesophageal hernias can be performed successfully laparoscopically in the majority of cases with acceptable morbidity and peri-operative outcomes in comparison to primary surgery.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>39433587</pmid><doi>10.1007/s00464-024-11325-5</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0003-4909-205X</orcidid></addata></record> |
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| subjects | Abdominal Surgery Aged Female Gastroenterology Gynecology Hepatology Hernia, Hiatal - surgery Hernias Herniorrhaphy - methods Hospitals, High-Volume Humans Laparoscopy - methods Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Middle Aged Patients Postoperative Complications - epidemiology Postoperative Complications - etiology Proctology Recurrence Reoperation - statistics & numerical data Retrospective Studies Surgery Tertiary Care Centers Treatment Outcome |
| title | Outcomes after revisional surgery for paraesophageal hernias at a high-volume tertiary care center |
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