Urgent laparoscopic repair of acutely symptomatic PEH is safe and effective.
BACKGROUND
Acute incarceration of paraesophageal hernias (PEHs) requiring urgent or emergent surgery is rare. Patients are often elderly with significant comorbidities and have historically been treated with open abdominal or thoracic incisions. Our study was designed to evaluate the feasibility, safety, and efficacy of laparoscopic paraesophageal hernia repair (LPEHR) in patients with PEH and acute gastric volvulus.


METHODS
We reviewed our prospectively maintained database and identified 269 patients who underwent an initial LPEHR between January 2003 and January 2012. Patients were divided into group A (acute), group B (age- and comorbidity-matched 1:3), and group C (all elective repairs). Group A included those admitted with acute symptoms related to PEH and underwent urgent repair. Patient age, Charlson score, operative time, length of stay (LOS), morbidity, mortality, and recurrence rates were compared.


RESULTS
Patients who underwent urgent LPEHR had a higher perioperative morbidity rate than the elective and matched groups. The overall mortality rate was low and no statistical difference was found between groups A, B, and C. LOS in group A was longer than groups B and C. The need for ICU admission was also higher in group A. There was no statistical difference in recurrence rates.


CONCLUSIONS
Historically, patients presenting with acute symptoms related to PEH have required open repair, which is associated with significant morbidity and mortality. The acute group was older and sicker than our elective LPEHR patients and had more adverse events resulting in a longer LOS, even when compared with comorbidity-matched elective patients. However, the LOS remained shorter than that reported for open repair and there was no mortality. The recurrence rates in all groups were low and comparable to elective repairs.
Department of Surgery, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA, dm.parker@hotmail.com.
David M
DM
Parker
Amrit
A
Rambhajan
Katherine
K
Johanson
Anna
A
Ibele
Jon D
JD
Gabrielsen
Anthony T
AT
Petrick
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013277:Stomach Volvulus / Q000150:complications / Q000601:surgery; D015996:Survival Rate