Pather Keouna, Dowdall Ryan, Mobley Erin M, Sacco Jana, Puri Ruchir
Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th St, Jacksonville, FL, 32209, USA.
Surg Endosc. 2025 Jul;39(7):4558-4563. doi: 10.1007/s00464-025-11847-6. Epub 2025 Jun 9.
Emergent repair of paraesophageal hernias (PEHs) is rare. This study aimed to compare outcomes of elective and urgent PEH repairs in patients with type II-IV PEHs.
This was a single-center retrospective review of type II-IV PEHs from February 2014 to April 2024. The operations were classified as elective or urgent. Indications for urgent repair included acute incarceration and/or gastric outlet obstruction, which required immediate NGT decompression and/or EGD followed by definitive repair during the same hospital admission. Outcomes were 90-day hernia recurrence, mortality, readmission, and reoperation. Significant associations between operative cohort and outcomes were evaluated using univariable logistic regression.
A total of 207 patients were included (female: 82%, median age: 64 years, ASA III: 57%). Type III PEH was most frequent (n = 116, 56%), followed by type IV (n = 64, 31%). There were 21 patients included in the urgent cohort. Of these, gastric decompression was performed via EGD in 16 patients (76%) and only NGT placement in two patients (10%). The median time to definitive repair was 6 [IQR 1.0-13.5] days. Laparoscopic (n = 126, 61%) and robotic (n = 75, 36%) approaches were similar between the elective and urgent cohorts (p = 0.70). Nissen fundoplication (n = 108, 52%) was the most common anti-reflux operation performed. The median length of stay (3 vs 4 days, p = 0.10) and hernia recurrence (n = 3 vs n = 1, p = 0.32) were comparable between the cohorts. There was one mortality in the urgent cohort secondary to a respiratory complication. Reoperations occurred in four patients, all in the elective cohort for gastric perforation, ischemic Roux limb, and early postoperative recurrence (n = 2). Readmissions included 18 (10%) and 3 patients (14%) from the elective and urgent cohorts, respectively (p = 0.55).
Acutely incarcerated PEHs are infrequent and require immediate gastric decompression. In stable patients, definitive urgent MIS repair can be performed safely during the same admission, with low risk of postoperative complications or recurrence, comparable to elective operations.
食管旁疝（PEH）的急诊修复很少见。本研究旨在比较II-IV型PEH患者择期和急诊修复的结果。
这是一项对2014年2月至2024年4月期间II-IV型PEH患者的单中心回顾性研究。手术分为择期或急诊。急诊修复的指征包括急性嵌顿和/或胃出口梗阻，这需要立即进行鼻胃管减压和/或上消化道内镜检查（EGD），随后在同一住院期间进行确定性修复。结果指标为90天疝复发、死亡率、再入院率和再次手术率。使用单变量逻辑回归评估手术队列与结果之间的显著关联。
共纳入207例患者（女性：82%，中位年龄：64岁，美国麻醉医师协会III级：57%）。III型PEH最常见（n = 116，56%），其次是IV型（n = 64，31%）。急诊队列中有21例患者。其中，16例患者（76%）通过EGD进行胃减压，仅2例患者（10%）放置鼻胃管。确定性修复的中位时间为6天[四分位间距1.0 - 13.5天]。择期和急诊队列中腹腔镜手术（n = 126，61%）和机器人手术（n = 75，36%）的比例相似（p = 0.70）。Nissen胃底折叠术（n = 108，52%）是最常见的抗反流手术。队列之间的中位住院时间（3天对4天，p = 0.10）和疝复发率（n = 3对n = 1，p = 0.32）相当。急诊队列中有1例因呼吸并发症死亡。4例患者进行了再次手术，均在择期队列中，原因是胃穿孔、Roux袢缺血和术后早期复发（n = 2）。择期和急诊队列的再入院率分别为患者的18例（10%）和3例（14%）（p = 0.55）。
急性嵌顿性PEH很少见，需要立即进行胃减压。对于病情稳定的患者，在同一住院期间可以安全地进行确定性急诊微创手术修复，术后并发症或复发风险低，与择期手术相当。
