Latorre-Rodríguez Andrés R, Rajan Ajay, Mittal Sumeet K
Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud - Universidad del Rosario, Bogotá D.C., Colombia.
Dis Esophagus. 2025 Jan 7;38(1). doi: 10.1093/dote/doae117.
Minimally invasive hiatal hernia (HH) repair is the gold standard for correcting mechanical defects of the crural diaphragm due to its safety and favorable clinical outcomes (i.e., relief of patient symptoms). However, several operative factors, including HH size, may negatively affect the postoperative course. We sought to determine if an increase in HH size was associated with an increased risk of perioperative complications, ICU admission, or hospital readmissions after minimally invasive HH repair.
We conducted a retrospective observational cohort study of patients who underwent primary HH repair by an experienced foregut surgeon between September 2016 and July 2023. Four groups were defined based on the percentage of stomach at the thorax determined during surgery (small-HH: <25%, moderate-HH: 25-49%, large-HH: 50-74%, and intrathoracic stomach [ITS]: ≥75%). Covariates were compared between the groups, and logistic regressions were performed to identify factors associated with postoperative morbidity.
A total of 391 patients (73.7% female; mean age, 64.4 ± 12.5 years) comprised the groups: small-HH (n = 160), moderate-HH (n = 63), large-HH (n = 64), and ITS (n = 104). Patients with ITS were older (p < 0.001), had longer operations (p < 0.001), greater blood loss (p < 0.001), longer hospital stays (p < 0.001), and an increased risk of early postoperative complications (aOR 2.59 [CI95: 1.28-5.25], p = 0.009) and ICU admission (aOR 13.3 [CI95: 3.10-57.06], p < 0.001).
An increase in HH size was associated with an increased risk of early postoperative complications, ICU admission, and a trend toward higher 30- and 90-day hospital readmissions, likely due to the progressive nature of the disease.
微创食管裂孔疝（HH）修补术因其安全性和良好的临床效果（即缓解患者症状），是纠正膈肌脚机械性缺陷的金标准。然而，包括HH大小在内的几个手术因素可能会对术后病程产生负面影响。我们试图确定HH大小增加是否与微创HH修补术后围手术期并发症、入住重症监护病房（ICU）或再次入院风险增加相关。
我们对2016年9月至2023年7月期间由一位经验丰富的前肠外科医生进行原发性HH修补术的患者进行了一项回顾性观察队列研究。根据手术中确定的胸腔内胃的百分比定义了四组（小HH：<25%，中度HH：25 - 49%，大HH：50 - 74%，以及胸腔内胃[ITS]：≥75%）。比较了各组之间的协变量，并进行逻辑回归以确定与术后发病率相关的因素。
共有391例患者（73.7%为女性；平均年龄64.4±12.5岁）纳入各组：小HH组（n = 160）、中度HH组（n = 63）、大HH组（n = 64）和ITS组（n = 104）。ITS组患者年龄更大（p < 0.001）、手术时间更长（p < 0.001）、失血量更多（p < 0.001）、住院时间更长（p < 0.001），且术后早期并发症风险增加（调整后比值比[aOR] 2.59 [95%置信区间：1.28 - 5.25]，p = 0.009）以及入住ICU的风险增加（aOR 13.3 [95%置信区间：3.10 - 57.06]，p < 0.001）。
HH大小增加与术后早期并发症、入住ICU风险增加以及30天和90天再次入院率升高的趋势相关，这可能归因于该疾病的进展性特点。
