A Comparison of Short-term Outcomes in Paraesophageal Hernia Repairs With and Without Concomitant Laparoscopic Cholecystectomy

Curtis E Bower, MD, FACS, Daniel L Davenport, PhD, John S Roth, MD, FACS

University of Kentucky, Department of Surgery

Introduction: Laparoscopic cholecystectomy is a common surgical procedure, and as such, is often performed in conjunction with other procedures. Combined procedures and incidental operations are frequently associated with worse outcomes than isolated procedures. We aim to compare short term outcomes following paraesophageal hernia repair with and without concomitant laparoscopic cholecystectomy.

Methods: The ACS NSQIP dataset from 2005-2010 was queried. All paraesophageal codes were included and compared to those with concomitant laparoscopic cholecystectomy (CLC). Cases with any other secondary procedure codes were excluded. There were 9282 cases with isolated paraesophageal hernia (IPEH) and 297 with CLC identified. Chi-Square and Fisher’s exact test were used to perform statistical analysis where appropriate.

Results: Mean BMI, ASA class, albumin, and all other risk factors in NSQIP were similar in the two groups. Age was 2.2 y higher in the CLC (p=.014). Serum Albumin was 0.1 g/dL lower in CLC group (p = .001). Alk Phos > 125 was 2.1% in IPEH and 6.1% in CLC group (p < 0.001). Intraoperative transfusion was similarly rare in both groups, 0.3% IPEH, 0.5% CLC. Operative time was increased from 129 +/- 59 minutes in the IPEH group to 152 +/- 62 in the CLC group (p < 0.001). Wound class was more often clean-contaminated in CLC group 89.2% than in IPEH 27.6%. Mortality was low but significantly higher in the CLC (1.0%) versus IPE (0.2%) group (p=0.023). Wound infection rates were low and not significantly different. Pulmonary complications were low but higher in the CLC group (p<0.05). Median length of stay increased from 1 (IQR 1-2) IPEH to 2 (IQR 1-2.75) CLC (p=0.057).

Conclusions: Laparoscopic cholecystectomy is a common procedure that frequently is performed concomitantly with other procedures. There is a significant, although low, increased risk of death and pulmonary complications associated with combined paraesophageal hernia repair and cholecystectomy when compared to paraesophageal hernia repair alone. Hospital length of stay is also increased with the combined procedures. Although these increased risks are small, they are still significant and thoughtful consideration should be given to each patient to individualize their care and determine the best course of action.

Session: Poster Presentation

Program Number: P624

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