Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
London Health Sciences Centre, London, ON, Canada.
Surg Endosc. 2024 Oct;38(10):5596-5600. doi: 10.1007/s00464-024-11113-1. Epub 2024 Aug 2.
There is a paucity of literature comparing safety outcomes between formal fundoplication and gastric fixation procedures for hiatal hernia repairs, especially in the emergency setting. The objective of this study was to evaluate 30-day clinical outcomes between fundoplication and gastric fixation performed in emergency hiatal hernia repairs.
A retrospective cohort study using the National Surgery Quality Improvement Program (NSQIP) database from 2011 to 2021 was conducted. The study population was determined using ICD9/10 codes describing diaphragmatic hernia without obstruction or gangrene, with obstruction, and with gangrene. Elective cases were excluded. CPT codes were used to group fundoplication procedures and gastric fixation procedures. The primary outcome was the 30-day complication rate. Secondary outcomes included 30-day readmission, reoperation and mortality rates. A multivariable logistic regression analysis was used to adjust for clinically relevant confounding variables.
A total of 971 and 346 were in the fundoplication and gastric fixation groups, respectively. Fundoplication was associated with a significantly lower (p < 0.05) 30-day complication, reoperation and mortality rates. There was no statistically significant difference with respect to readmission. After adjustment, fundoplication was significantly associated with a decrease in odds of 30-day complications (OR 0.53, p < 0.001 95% CI 0.40-0.71) and mortality (OR 0.55, p = 0.033 95% CI 0.32-0.95). However, there was no significant difference with respect to 30-day readmission (OR 0.86, p = 0.449 95% CI 0.59-1.27) and reoperation (OR 0.66, p = 0.063 95% CI 0.42-1.02).
Patients with hiatal hernias that underwent emergent repair with fundoplication had a significantly lower 30-day complication and mortality rates compared to those who underwent gastric fixation procedures. Fundoplication is a safe and feasible approach to manage hiatal hernias in the emergency setting for select patients.
在比较食管裂孔疝修复术中医源性胃固定术和正式胃底折叠术的安全性结果方面，文献相对较少，尤其是在急诊环境下。本研究的目的是评估在急诊食管裂孔疝修复术中使用胃底折叠术和胃固定术的 30 天临床结果。
采用 2011 年至 2021 年国家手术质量改进计划（NSQIP）数据库进行回顾性队列研究。使用描述无梗阻或坏疽、有梗阻和有坏疽的膈疝的 ICD9/10 代码确定研究人群。排除择期病例。使用 CPT 代码将胃底折叠术和胃固定术分组。主要结果是 30 天并发症发生率。次要结果包括 30 天再入院、再次手术和死亡率。使用多变量逻辑回归分析调整临床相关混杂变量。
胃底折叠术组和胃固定术组分别有 971 例和 346 例。胃底折叠术与 30 天并发症、再次手术和死亡率显著降低（p<0.05）相关。两组间再入院率无统计学差异。调整后，胃底折叠术与 30 天并发症（OR 0.53，p<0.001，95%CI 0.40-0.71）和死亡率（OR 0.55，p=0.033，95%CI 0.32-0.95）显著降低相关。然而，两组间 30 天再入院率（OR 0.86，p=0.449，95%CI 0.59-1.27）和再次手术率（OR 0.66，p=0.063，95%CI 0.42-1.02）无显著差异。
与接受胃固定术的患者相比，接受胃底折叠术的食管裂孔疝患者的 30 天并发症和死亡率显著降低。胃底折叠术是一种安全可行的方法，适用于某些患者的急诊食管裂孔疝治疗。
