Guillaume S Chevrollier, MD, Andrew M Brown, MD, Ellika Salari, BS, Charles P McCann, MD, Michael J Pucci, MD, Karen A Chojnacki, MD, Ernest L Rosato, MD, Francesco Palazzo, MD. Sidney Kimmel Medical College of Thomas Jefferson University, Department of Surgery
INTRODUCTION: Cameron ulcers (CU) are linear erosions or ulcerations in the gastric mucosa at the level of the diaphragmatic hiatus in patients with a hiatal hernia (HH) and are frequently associated with anemia. Perioperative outcomes of patients with CU undergoing HH repair are not well described. We sought to identify the incidence of CU in patients undergoing HH repair at our institution and determine whether the presence of CU impacted postoperative outcomes.
METHODS AND PROCEDURES: Using our IRB-approved institutional HH database, we retrospectively identified patients undergoing repair between January 2011 and April 2017. We identified all patients with CU found on preoperative esophagogastroduodenoscopy (EGD). We compared patients with and without CU to determine if they differed in terms of preoperative anemia (defined as hemoglobin levels less than 13 mg/dL in men and 12 mg/dL in women). Lastly, we compared outcomes between the CU group and the non-CU group, focusing on need for perioperative blood transfusion, failure to extubate postoperatively, intensive care unit (ICU) admission, postoperative complications, length of stay (LOS), and 30-day readmission.
RESULTS: We identified 266 patients undergoing HH repair, of which 230 (86%) had documented preoperative EGDs. The average age was 63 years and the majority of patients (78%, n=180) were female. Most underwent elective repair (n=219, 95%) and 96% (n=222) underwent minimally invasive repair. The incidence of CU was 30% (n=69). Patients with CU had significantly greater incidence of preoperative anemia compared to those without (38% vs. 21%, p=0.009). There was no significant difference between groups in rate of perioperative blood transfusion (2.9% vs 1.2%, p=0.38), failure to extubate postoperatively (5.8% vs. 1.2%, p=0.068), postoperative complications (29% vs. 19.9%, p=0.13), and 30-day readmissions (10.1% vs 6.8%, p=0.425). However, the presence of CU was associated with a significant increase in median postoperative LOS (3 days vs. 2 days, p= 0.05) and ICU admission (11.6% vs. 3.7%, p=0.033).
CONCLUSIONS: The presence of CU on preoperative EGD is associated with increased rate of preoperative anemia, increased LOS, and increased ICU admission after HH repair. Although the cause of anemia in patients with HH is commonly attributed to CU, only 38% of CU patients were anemic, indicating that differences in outcomes may not only be attributed to a higher incidence of anemia in CU patients. The implications of CU in patients undergoing HH repair need to be further elucidated.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86998
Program Number: P444
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster