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

Michael Klinginsmith, Jennifer Jolley, Daniel Lomelin, Crystal Krause, Jace Heiden, Dmitry Oleynikov

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Methods: Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Results: Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1790-1795
Number of pages6
JournalSurgical endoscopy
Volume30
Issue number5
DOIs
StatePublished - May 1 2016

Fingerprint

Fundoplication
Hiatal Hernia
Herniorrhaphy
Laparoscopy
Emergencies
Gastrostomy
International Classification of Diseases
Standard of Care
Databases

Keywords

  • Anti-reflux procedure
  • Elective surgery
  • Emergent surgery
  • Gastrostomy tube
  • Laparoscopic surgery
  • Open surgery
  • Paraesophageal hernia

ASJC Scopus subject areas

  • Surgery

Cite this

Paraesophageal hernia repair in the emergency setting : is laparoscopy with the addition of a fundoplication the new gold standard? / Klinginsmith, Michael; Jolley, Jennifer; Lomelin, Daniel; Krause, Crystal; Heiden, Jace; Oleynikov, Dmitry.

In: Surgical endoscopy, Vol. 30, No. 5, 01.05.2016, p. 1790-1795.

Research output: Contribution to journalArticle

Klinginsmith, Michael ; Jolley, Jennifer ; Lomelin, Daniel ; Krause, Crystal ; Heiden, Jace ; Oleynikov, Dmitry. / Paraesophageal hernia repair in the emergency setting : is laparoscopy with the addition of a fundoplication the new gold standard?. In: Surgical endoscopy. 2016 ; Vol. 30, No. 5. pp. 1790-1795.
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abstract = "Background: Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Methods: Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Results: Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 {\%} were performed laparoscopically and 15.3 {\%} open. 24.6 {\%} of cases were classified urgent/emergent upon admission, and almost 70 {\%} of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 {\%} of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 {\%} LHR vs. 26.3 {\%} OHR). Almost 90 {\%} of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. Conclusion: 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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AU - Krause, Crystal

AU - Heiden, Jace

AU - Oleynikov, Dmitry

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N2 - Background: Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Methods: Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Results: Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. Conclusion: 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.

AB - Background: Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Methods: Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Results: Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. Conclusion: 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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