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Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair

BACKGROUND AND OBJECTIVES: A feared complication of large paraesophageal hernias is incarceration necessitating emergent repair. According to previous studies, patients who require an emergent operation are subject to increased morbidity compared with patients undergoing elective operations. In this...

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Autores principales: Shea, Brian, Boyan, William, Decker, Jonathan, Almagno, Vincent, Binenbaum, Steven, Matharoo, Gurdeep, Squillaro, Anthony, Borao, Frank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600053/
https://www.ncbi.nlm.nih.gov/pubmed/31285652
http://dx.doi.org/10.4293/JSLS.2019.00015
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author Shea, Brian
Boyan, William
Decker, Jonathan
Almagno, Vincent
Binenbaum, Steven
Matharoo, Gurdeep
Squillaro, Anthony
Borao, Frank
author_facet Shea, Brian
Boyan, William
Decker, Jonathan
Almagno, Vincent
Binenbaum, Steven
Matharoo, Gurdeep
Squillaro, Anthony
Borao, Frank
author_sort Shea, Brian
collection PubMed
description BACKGROUND AND OBJECTIVES: A feared complication of large paraesophageal hernias is incarceration necessitating emergent repair. According to previous studies, patients who require an emergent operation are subject to increased morbidity compared with patients undergoing elective operations. In this study, we detail patients who underwent hernia repair emergently and compare their outcomes with elective patients. METHODS: A retrospective analysis was performed of the paraesophageal hernia repair operations between 2010 and 2016. Patients were divided into 2 groups: patients with hernias that were repaired electively and patients with hernias that were repaired emergently. Perioperative complications and follow-up data regarding morbidity, mortality, and recurrence were also recorded. A propensity analysis was used to compare emergent and elective groups. RESULTS: Thirty patients had hernias repaired emergently, and 199 patients underwent elective procedures. Patients undergoing emergent repair were more likely to have a type IV hernia, have a partial gastrectomy or gastrostomy tube insertion as part of their procedure, have a postoperative complication, and have a longer hospital stay. However, propensity analysis was used to demonstrate that when characteristics of the emergent and elective groups were matched, differences in these factors were no longer significant. Having an emergent operation did not increase a patient's risk for recurrence. CONCLUSION: Patients who had their hernias repaired emergently experienced complications at similar rates as those of elective patients with advanced age or comorbid conditions as demonstrated by the propensity analysis. The authors therefore recommend evaluation of all paraesophageal hernias for elective repair, especially in younger patients who are otherwise good operative candidates.
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spelling pubmed-66000532019-07-08 Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair Shea, Brian Boyan, William Decker, Jonathan Almagno, Vincent Binenbaum, Steven Matharoo, Gurdeep Squillaro, Anthony Borao, Frank JSLS Research Article BACKGROUND AND OBJECTIVES: A feared complication of large paraesophageal hernias is incarceration necessitating emergent repair. According to previous studies, patients who require an emergent operation are subject to increased morbidity compared with patients undergoing elective operations. In this study, we detail patients who underwent hernia repair emergently and compare their outcomes with elective patients. METHODS: A retrospective analysis was performed of the paraesophageal hernia repair operations between 2010 and 2016. Patients were divided into 2 groups: patients with hernias that were repaired electively and patients with hernias that were repaired emergently. Perioperative complications and follow-up data regarding morbidity, mortality, and recurrence were also recorded. A propensity analysis was used to compare emergent and elective groups. RESULTS: Thirty patients had hernias repaired emergently, and 199 patients underwent elective procedures. Patients undergoing emergent repair were more likely to have a type IV hernia, have a partial gastrectomy or gastrostomy tube insertion as part of their procedure, have a postoperative complication, and have a longer hospital stay. However, propensity analysis was used to demonstrate that when characteristics of the emergent and elective groups were matched, differences in these factors were no longer significant. Having an emergent operation did not increase a patient's risk for recurrence. CONCLUSION: Patients who had their hernias repaired emergently experienced complications at similar rates as those of elective patients with advanced age or comorbid conditions as demonstrated by the propensity analysis. The authors therefore recommend evaluation of all paraesophageal hernias for elective repair, especially in younger patients who are otherwise good operative candidates. Society of Laparoendoscopic Surgeons 2019 /pmc/articles/PMC6600053/ /pubmed/31285652 http://dx.doi.org/10.4293/JSLS.2019.00015 Text en © 2019 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Research Article
Shea, Brian
Boyan, William
Decker, Jonathan
Almagno, Vincent
Binenbaum, Steven
Matharoo, Gurdeep
Squillaro, Anthony
Borao, Frank
Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair
title Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair
title_full Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair
title_fullStr Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair
title_full_unstemmed Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair
title_short Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair
title_sort emergent repair of paraesophageal hernias and the argument for elective repair
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600053/
https://www.ncbi.nlm.nih.gov/pubmed/31285652
http://dx.doi.org/10.4293/JSLS.2019.00015
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