title: Utilization and outcomes of laparoscopic versus open paraesophageal hernia repair.
abstract: The optimal operative approach for repair of diaphragmatic hernia remains debated. The aim of this study was to examine the utilization of laparoscopy and compare the outcomes of laparoscopic versus open paraesophageal hernia repair performed at academic centers. Data was obtained  from the University HealthSystem Consortium database on 2726 patients who underwent a laparoscopic (n = 2069) or open (n = 657) paraesophageal hernia repair between 2007 and 2010. The data were reviewed for demographics, length of stay, 30-day readmission, morbidity, in-hospital mortality,  and costs. For elective procedures, utilization of laparoscopic repair was 81 per cent and was associated with a shorter hospital stay (3.7 vs 8.3 days, P < 0.01), less requirement for intensive care unit care (13% vs 35%, P < 0.01), and lower overall complications  (2.7% vs 8.4%, P < 0.01), 30-day readmissions (1.4% vs 3.4%, P < 0.01) and costs ($15,227 vs $24,263, P < 0.01). The in-hospital mortality was 0.4 per cent for laparoscopic repair versus 0.0 per cent for open repair. In  patients presenting with obstruction or gangrene, utilization of laparoscopic repair was 57 per cent and was similarly associated with improved outcomes compared with open repair. Within the context of academic centers, the current practice of paraesophageal hernia repair is mostly laparoscopy.  Compared with open repair, laparoscopic repair was associated with superior perioperative outcomes even in cases presenting with obstruction or gangrene.
authors: Department of Surgery, University of California, Irvine Medical Center, Orange, California 92868, USA. ninhn@uci.edu
authors: Ninh T
authors: NT
authors: Nguyen
authors: Catherine
authors: C
authors: Christie
authors: Hossein
authors: H
authors: Masoomi
authors: Taraneh
authors: T
authors: Matin
authors: Kelly
authors: K
authors: Laugenour
authors: Samuel
authors: S
authors: Hohmann
mesh_terms: D002140:California / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000191:economics / Q000401:mortality / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics / Q000379:methods*; D017721:Hospital Costs; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome