title: Minimally Invasive Surgery Should Be the Standard of Care for Paraesophageal Hernia Repair.
abstract: It is unclear if minimally invasive surgery (MIS) has been universally embraced for paraesophageal hernia (PEH) repair. The aims of this study were: (a) to assess the national utilization of MIS for PEH repair and (b) to compare the perioperative outcomes between MIS and open procedures METHODS: A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000-2013. Adult patients (≥18 years old) who underwent PEH repair were included. Linear and logistic regression, adjusted for patient and hospital characteristics, were used to assess the effect of minimally invasive surgery on patient outcomes RESULTS: A total of 63,812 patients were included. An abdominal approach was used in 60,087 (94.2%) patients and a thoracic approach in 3725 (5.8%) cases. Between 2000 and 2013, the rate of MIS significantly increased in abdominal and thoracic procedures. Patients undergoing MIS were less likely to experience postoperative infection, bleeding, cardiac failure, renal failure, respiratory failure, shock, and had a lower inpatient mortality. In addition, MIS significantly reduced the length of hospital stay and the overall cost.
  
  
  
  MIS is associated with significantly better perioperative outcomes and lower costs. These data strongly support the MIS approach as standard of care for PEH repair.
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. fschlottmann@hotmail.com.|Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA. fschlottmann@hotmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Schlottmann
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.|Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Paula D
authors.initials: PD
authors.lastname: Strassle
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.|Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Farrell
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.|Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006551:Hernia, Hiatal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D059039:Standard of Care / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Minimally invasive surgery; Paraesophageal hernia; Paraesophageal hernia repair