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Laparoscopic and robotic paraesophageal hernia repair in United States veterans: Clinical outcomes and risk factors associated with reoperation recurrence

  • Celsa M. Tonelli
    Affiliations
    Edward Hines Jr., Veterans Administration Medical Center, Hines, IL, United States

    Department of Surgery, Loyola University Medical Center, Maywood, IL, United States
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  • Marshall S. Baker
    Affiliations
    Edward Hines Jr., Veterans Administration Medical Center, Hines, IL, United States

    Department of Surgery, Loyola University Medical Center, Maywood, IL, United States
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  • Fred A. Luchette
    Affiliations
    Edward Hines Jr., Veterans Administration Medical Center, Hines, IL, United States

    Department of Surgery, Loyola University Medical Center, Maywood, IL, United States
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  • Tyler Cohn
    Correspondence
    Corresponding author. Edward Hines Jr., Veterans Administration Medical Center; Hines, IL, United States.
    Affiliations
    Edward Hines Jr., Veterans Administration Medical Center, Hines, IL, United States

    Department of Surgery, Loyola University Medical Center, Maywood, IL, United States
    Search for articles by this author
Published:December 18, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.12.013

      Highlights

      • There are low rates of reoperation for paraesophageal hernia recurrence after repair.
      • Emergency paraesophageal hernia repair is associated with an increased risk of undergoing reoperation for hernia recurrence.
      • The use of robotic approach is rising and is not associated with increased risk of recurrence requiring reoperation.

      Abstract

      Background

      Despite surgical advances, rates of paraesophageal hernia recurrence remain high. We evaluate outcomes of paraesophageal hernia repair in United States veterans, safety of robotic technology, and risk factors for reoperation for recurrence.

      Methods

      The Veterans Affairs Surgical Quality Improvement Program database was queried for patients undergoing laparoscopic or robotic paraesophageal hernia repair from 2010 to 2021. The effect of patient and operative characteristics on outcomes was evaluated.

      Results

      2,444 patients underwent paraesophageal hernia repair. 62 (2.5%) had a reoperation for recurrence. Emergent priority (aOR 18.3 [5.9–56.2]) and younger age (aOR 0.7 [0.5–0.9]) were associated with increased risk of reoperation. On comparison of propensity matched cohorts, repairs done robotically took longer (4.17 vs. 3.57 h, p < 0.001) but had 30-day outcomes and rates of reoperation for recurrence equivalent to laparoscopic repairs (p > 0.05).

      Conclusion

      Emergent priority and younger age are associated with increased risk of reoperation for recurrent paraesophageal hernia. Robotic approaches take longer but are safe.

      Keywords

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      References

        • Dallemagne B.
        • Kohnen L.
        • Perretta S.
        • et al.
        Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate.
        Ann Surg. 2011 Feb; 253: 291-296
        • Watson D.I.
        • Thompson S.K.
        • Devitt P.G.
        • et al.
        Five year follow-up of a randomized controlled trial of laparoscopic repair of very large hiatus hernia with sutures versus absorbable versus nonabsorbable mesh.
        Ann Surg. 2020 Aug; 272: 241-247
        • Gerull W.D.
        • Cho D.
        • Kuo I.
        • et al.
        Robotic approach to paraesophageal hernia repair results in low long-term recurrence rate and beneficial patient-centered outcomes.
        J Am Coll Surg. 2020 Nov; 231: 520-526
        • Ward M.A.
        • Hasan S.S.
        • Sanchez C.E.
        • et al.
        Complications following robotic Hiatal hernia repair are higher compared to laparoscopy.
        J Gastrointest Surg. 2021 Dec; 25: 3049-3055
        • Wang Z.
        • Bright T.
        • Irvine T.
        • et al.
        Outcome for asymptomatic recurrence following laparoscopic repair of very large hiatus hernia.
        J Gastrointest Surg. 2015; 19: 1385-1390
        • O'Connor S.C.
        • Mallard M.
        • Desai S.S.
        • et al.
        Robotic versus laparoscopic approach to Hiatal hernia repair: results after 7 Years of robotic experience.
        Am Surg. 2020 Sep; 86: 1083-1087