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
- 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
- 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
- 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
- Complications following robotic Hiatal hernia repair are higher compared to laparoscopy.J Gastrointest Surg. 2021 Dec; 25: 3049-3055
- Outcome for asymptomatic recurrence following laparoscopic repair of very large hiatus hernia.J Gastrointest Surg. 2015; 19: 1385-1390
- Robotic versus laparoscopic approach to Hiatal hernia repair: results after 7 Years of robotic experience.Am Surg. 2020 Sep; 86: 1083-1087
Article info
Publication history
Published online: December 18, 2022
Accepted:
December 17,
2022
Received in revised form:
December 14,
2022
Received:
August 26,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
☆This manuscript has been seen and reviewed by all authors, and the material presented has not been published previously. The contents of this work were presented as a poster at the Midwest Surgical Association Annual Meeting on August 8, 2022, at Mackinac Island, MI.
Identification
Copyright
© 2022 Published by Elsevier Inc.
