• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Descriptions and Video Updates
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • COVID-19 Announcements
    • SAGES 2021 Meeting Information
    • 2021 Scientific Session Call For Abstracts
    • 2021 The Next Big Thing (Formerly Emerging Technology) Call For Abstracts
    • 2018 Prevent BDI Consensus Conference
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • Leadership Development and Health Policy Conference Videos
      • SAGES Quality Summit Meeting
      • SAGES 2019
      • SAGES 2018
      • SAGES 2017
      • SAGES 2016
      • SAGES 2015
      • SAGES 2014
      • SAGES 2013
    • Related Meetings Calendar
  • Membership
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • COVID-19 Annoucements
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • Troubleshooting Guides
  • Education
    • SAGES.TV Video Library
    • Virtual Hernia Clinic
    • The SAGES Safe Cholecystectomy Program
    • The Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • The SAGES HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Endorsed Courses
    • SAGES Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Educational Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES Quality Initiative
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Research Opportunities
    • SAGES Endorsed Courses
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
    • Fellowship Certification
  • Search
    • COVID-19 Announcements
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • All Blog Posts
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
  • Log In

PERI-OPERATIVE OUTCOMES AFTER ELECTIVE AND EMERGENT REPAIR OF GIANT PARA-ESOPHAGEAL HERNIA IN THE MODERN ERA – SHOULD EARLY LAPAROSCOPIC REPAIR BE OFFERED MORE LIBERALLY?

Rafik Sorial, Julio F. Fiore Jr, Jonathan Spicer, Melina Vassiliou, Gerald M Fried, Liane S Feldman, Lorenzo E Ferri, Lawrence Lee, Carmen L Mueller. McGill University Health Center

Introduction: Historically, surgery was offered to all patients with giant paraesophageal hernia to avoid the risks of gastric volvulus and incarceration. A paradigm shift occurred 15 years ago when decision-model analysis showed watchful waiting to be superior to elective laparoscopic repair (LPEHR) for elderly and minimally symptomatic patients due to high rates of morbidity and mortality with elective surgery. Recent reports suggest modern era outcomes have improved, such that elective repair may now be favorable for more patients. Furthermore, the morbidity of emergency surgery may still be significant.

The objectives of this study were to compare modern-era surgical outcomes after elective and emergency repair of giant paraesophageal hernias at a high volume tertiary care center.

Methods: A retrospective review was conducted of all Type II-IV paraesophageal hernia repairs performed between Jan 1, 2012-Sept 15, 2017. Type I hiatal hernias (HH), HHs after esophagectomy, and cases with planned simultaneous procedures other than cholecystectomy were excluded from the final analysis. Comparisons between groups were made using t-test for continuous variables and chi squared test for categorical variables. Multiple logistic regression was used to identify independent risk factors for morbidity.

Results: A total of 309 cases were reviewed of which 194 met inclusion criteria (17 emergency, 177 elective). Eight had Type II PEH, 141 had Type III, and 45 had Type IV. Emergency patients were older (78 (SD12.8) vs 70 (SD10.6) years; p=0.003), more comorbid (ASA ≥ 3: 94% vs 33%, p<0.0001), and more likely to undergo gastrostomy tube insertion (23.5% vs 0%, p=0.003). Mean length of stay was shorter in the elective group: 2 (SD2.8) vs. 11 (SD17.7) days, p<0.0001, and emergency patients were less likely to return directly to their original residence at discharge (70.6% vs 99.4%, p<0.0001). There were significantly more major complications (Clavien-Dindo score ≥3) in the emergency group (29.4% vs 5.6%, p=0.006). Type of PEH, conversion to open, operative time, blood loss, splenectomy, gastric perforation, 30-day ER visits, readmission and re-operation rates were similar between groups. There were no peri-operative deaths in either group. In the elective group, age was not an independent risk factor for complications (OR 1.05, 95%CI 0.98-1.12).

Conclusions: The incidence of major complications and mortality in this series were much lower than those previously reported for elective LPEHR, while morbidity after emergency repair remains high. The paradigm of watchful waiting for elderly and/or minimally symptomatic patients with giant PEH should be revisited.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87769

Program Number: P449

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

Post Views: 8

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2018 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Daniel Herron, MD

An opportunity to slow down and appreciate the small joys in life

Dan Herron, MD shares insights with Dana Telem, MD on lessons learned from COVID-19 Fear, anxiety and uncertainty has dominated the first half of 2020. Never before have we, as healthcare providers, been asked to do so much with so little—whether it’s resources like personal protective equipment, dusting off skills related to critical care, or […]

covid testing stock

Notes from the Battlefield – May 14, 2020

Coronavirus Global Surgical Collaborative (CVGSC)* An initiative sponsored by SAGES in collaboration with EAES, AEC, KSELS, and ELSA A group of surgical leaders from affected countries have joined to discuss what they are learning during this Covid-19 Global crisis. The following is a brief summary of what they feel may be useful information to disseminate to the surgical […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Newsletter Subscription

  • This field is for validation purposes and should be left unchanged.

Important Links

SAGES 2020 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

[footer_backtotop] · Log in

Copyright © 2021 Society of American Gastrointestinal and Endoscopic Surgeons · Legal
· Managed by BSC Management, Inc