Sarah Samreen, MD, Bhavani Pokala, MD, Laura E Flores, Priscila R Armijo, MD, Dmitry Oleynikov, MD. University of Nebraska Medical Center
Introduction: Paraesophageal hernia repair (PEH) requires an adequate length of intra-abdominal esophagus. For the management of short esophagus, a collis gastroplasty can be performed to lengthen the functional distal esophagus. A fundoplication can then be performed without tension. Our aim was to examine the frequency and outcomes of PEH with and without Collis gastroplasty.
Methods: The 2014-2016 National Surgical Quality Improvement Program (NSQIP) database was analyzed for adults who underwent elective PEH performed by general or thoracic surgery. Emergent cases and those unable to be followed for 30 days were excluded. Cases with and without Collis gastroplasty were compared. Statistical analysis was performed using IBM SPSS 25.0, α=0.05
Results: 12,900 patients were included in this study (C:241; NC:12,599). Patient demographics and symptoms were similar with the exception of a higher rate of dyspnea (36% vs 16.5%; p=.017) and older mean age (64±12.7 vs 61±14.3 years) in the Collis group. Majority of cases were performed laparoscopically (C:84.2%, NC:92.6%) and by general surgeons (C:79.8%, NC:95.6%). 10.75% of PEH cases performed by thoracic surgeons included Collis gastroplasty vs 2.21% performed by general surgery (p=<.001). In the Collis group, there was significantly higher rates of organ space infection (2.6% vs 0.8%; p=.002), superficial site infection (12% vs 3.5%; p=.002), and sepsis (2.6% vs 0.7%; p=.001). Mean length of stay was also longer in the Collis group (3.89 vs 2.90; p=.001). Logistic regression revealed that open approach and Collis gastroplasty were independently associated with higher risk of superficial site infection (OR:3.378 and OR:6.611), organ space infection (OR:3.263 and OR:2.303), and sepsis (OR:3.681 and OR:3.492), all p<.05.
Conclusions: Collis gastroplasty is associated with increased morbidity. Short esophagus can often be elongated safely with extended mediastinal dissection to provide adequate intra-abdominal esophageal length and avoid the need for a Collis gastroplasty.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95468
Program Number: P504
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster