• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Predicting Operative Techniques and Outcomes in Laparoscopic Paraesophageal Hernia Repair (PEHR) by Computed Tomography (CT) Measurements

Predicting Operative Techniques and Outcomes in Laparoscopic Paraesophageal Hernia Repair (PEHR) by Computed Tomography (CT) Measurements

Samuel W Ross, MD, MPH, Blair A Wormer, MD, Bindhu Oommen, MD, MPH, Mimi Kim, MD, John D Watkins, Amanda L Walters, MS, Vedra A Augenstein, MD, Brant T Heniford, MD. Carolinas Medical Center, Dept. of Surgery, Division of Gastrointestinal and Minimally Invasive Surgery.

INTRODUCTION: Large PEHR can be challenging to plan pre-operatively given the multiple options for surgical repair. We hypothesized that greater dimensions of paraesophageal hernia (PEH) on pre-operative CT of would predict the need for salvage techniques in PEHR.

METHODS AND PROCEDURES: We queried our prospectively collected, institutional hernia-specific database for all PEHR from 2008 to March 2013. Only PEHR with pre-operative CT of the chest and/or abdomen were included. CT measurements of defect and hernia sac were obtained using transverse, coronal and sagittal views. Area and volume were calculated using standard formulas. CT measurements, esophageal length on upper endoscopy, and recurrent hernia status were then analyzed by operative techniques and patient outcomes using standard statistical methods; significance set at p≤0.05.

RESULTS: There were 103 laparoscopic PEHR, with three conversions to open. Mean age was 63.8±11.7 years, BMI was 30.2±12.8 kg/m2, and esophageal length was 35.2±3.7cm. The population was 35.0% male, 12.6% diabetic, 8.7% smoker. Distribution of PEH by classification was 17.5% Type I, 1.9% Type II, 57.3% type III and 23.3% Type IV PEH; 13.6% were emergent and 14.6% recurrent. There were no Collis gastroplasties; biologic mesh was used in 65.1%, and fundoplication was performed in 51.5%. Average CT measurements were as follows: defect width 4.5±2.0cm, depth 6.8±3.0cm, area 19.4±15.7 cm2; sac length 7.8±3.5cm, width 10.3±5.0cm, depth 6.8±3.1cm, area 74.4±59.1 cm2, volume 3,369±3,723 cm3. The crura could not be closed in 17.7%: salvage gastropexy was performed in 13.6%, and gastric diversion in 7.8%. Average length of stay was 5.8±6.9 days and inpatient charges were $61,285±48,749. There was a 4.6% recurrence rate, 6.3% required post-operative endoscopy, 7.3% had recurrent symptoms and there was one death. Operative techniques and patient outcomes association with pre-operative CT measurements are presented in the Table. Mesh use, reoperation, readmission, incisional hernia formation, and death were not associated with increased CT measurements or recurrent hernia; p>0.05. Esophageal length did not correlate with any operative techniques or outcomes; p>0.05.

CONCLUSION: Repair of large PEH requires a variety of techniques to adequately prevent reherniation and recurrent symptoms. Pre-operative CT measurements of defect area, hernia sac area and volume correlate with increased use of operative salvage techniques, post-operative complications, and charges. CT can be a valuable adjunct in operative planning and risk assessment in large and recurrent hernias. Additionally, recurrent hernia is an indicator that gastric diversion or other salvage technique is required.

130

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals