Thirty-Day Outcomes of Paraesophageal Hernia Repair Using the NSQIP Database: Should Laparoscopy Be the Standard of Care?

Mungo, Benedetto; Molena, Daniela; Stem, Miloslawa; Feinberg, Richard; Lidor, Anne O.

doi:10.1016/j.jamcollsurg.2014.02.030

Cited by 65 publications

(33 citation statements)

References 33 publications

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“…Although these operative steps are the same whether they are performed open or laparoscopically, multiple authors have reported that laparoscopic repair of hiatal hernias provides exceptional visualization, improves quality of life, and provides excellent relief from preoperative symptoms. 9,10,20 Briefly, the patient is placed in a modified lithotomy or split leg position. This provides the surgeon improved ergonomics by standing between the patient's legs; the assistant stands at the patient's left.…”

Section: Laparoscopic Paraesophageal Hernia Repairmentioning

confidence: 99%

“…The laparoscopic approach is associated with decreased perioperative morbidity, shorter length of stay, and lower cost. 9 Furthermore, laparoscopy provides superior visualization of the esophageal hiatus and posterior mediastinum compared to open surgery. Consequently, even in the setting of an urgent operation, laparoscopic management of gastric volvulus is preferred over open techniques.…”

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confidence: 99%

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Managing obstructive gastric volvulus: challenges and solutions

Rodriguez-Garcia¹,

Wright²,

Yates³

2017

OAS

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Gastric volvulus is the abnormal torsion of the stomach along its short or long axis. Most patients who experience gastric volvulus present with mild or intermittent gastric obstructive symptoms. However, severe acute gastric volvulus can result in complete gastric outlet obstruction and ischemia. Consequently, acute gastric volvulus warrants immediate evaluation and management. The goals of management are to relieve the obstruction and prevent recurrent volvulus. Techniques to manage gastric volvulus depend on patient characteristics and the presence of gastric ischemia. In the absence of gastric ischemia, gastric volvulus can be managed with anterior abdominal wall gastropexy or paraesophageal hernia repair. If gastric ischemia is present, operative resection of the affected portion of the stomach is indicated. When operative management is indicated, many patients with gastric volvulus can be managed with minimally invasive (laparoscopic, endoscopic, or laparoendoscopic) techniques.

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Section: Laparoscopic Paraesophageal Hernia Repairmentioning

confidence: 99%

mentioning

confidence: 99%

Managing obstructive gastric volvulus: challenges and solutions

Rodriguez-Garcia¹,

Wright²,

Yates³

2017

OAS

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“…The laparoscopic approach provides superior visualization of the surgical field compared to the open technique but it is technically challenging and good outcomes are hinged on good surgical technique and the surgeon's experience [2,6]. Morbidity and mortality rates associated with laparoscopic repair of paraesophageal hernias are relatively low, with previous studies reporting morbidity rates between 4 and 10% and a mortality rate from 0 to 1.7% [3,4,[6][7][8][9][10][11][12][13].…”

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confidence: 99%

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

et al. 2017

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“…This has been especially encouraged with the advancement of laparoscopy and the widely available high definition systems including the new 3D optical systems that have emerged mainly during the last quinquennium. It not only provides a better view of the hiatus and the lower mediastinum with subsequent improved oesophageal mobilisation compared to traditional open surgery, but also leads to shorter recovery time due to less postoperative pain and perioperative cardiopulmonary complications, as well as lower overall mortality [6]. However, repair of all paraoesophageal hernias in low-risk patients is still a matter of conflict.…”

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confidence: 99%

Paraoesophageal Hernias: A Surgical Perspective

Farhangmehr¹,

Liakakos²,

Àlex³

et al. 2017

J Gastrointest Dig Syst

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EditorialHiatal hernias refer to the condition where intra-abdominal structures herniate into the mediastinum through the oesophageal hiatus. They occur in about 10% of the population. Hiatal hernias are classified in 4 types. Type I or sliding hernia represents 85%-90% of all hiatal hernias. It results from laxity and loss of coherence of the phreno-oesophageal membrane. The gastro-oesophageal junction (GOJ) is displaced above the diaphragm while the fundus remains below the GOJ. Hiatal hernias type II, III and IV or collectively known as paraesophageal hernias represent about 10%-15% of hiatal hernias. Type II hernia results from a localized defect in the phrenooesophageal membrane. The gastric fundus herniates into the mediastinum, while the GOJ remains fixed to the preaortic fascia and the median arcuate ligament. Type III paraoesophageal hernias have elements of both types I and II and have both the GOJ and the fundus herniating through the hiatus. Type IV hiatus hernia is associated with a large defect in the diaphragm defined by the presence of organs other than the stomach in the hernia sac commonly being the transverse colon, spleen, pancreas or small bowel.Paraoesophageal hernia is a condition mainly seen in the elderly population. In most large series, presentation with a median age of 65 to 75 years appears to be the rule [1]. Risk factors for developing hiatal hernia include age greater than 50, BMI>25 and male gender [2]. About 50% of cases are asymptomatic and the hernia is an incidental finding on imaging or endoscopy. In sliding hernias reflux symptoms such as heartburn and regurgitation are more frequent; whilst in paraoesophagheal hernias common symptoms include epigastric or substernal pain, postprandial fullness, dysphagia, nausea, vomiting and dyspnoea. Microcytic anaemia can be present secondary to erosions of the gastric mucosa. Acute symptoms due to gastric outlet obstruction/ gastric volvulus, uncontrolled bleeding, strangulation, perforation, and respiratory compromise are indications for urgent surgery.Hiatus hernia can be an incidental finding on a chest X-ray where the gastric bubble can be seen in the chest. On barium swallow the presence of more than 2 cm separation between the B ring (level of squamocolumnar junction) and the diaphragm suggests a sliding hiatus hernia. If a B ring is not evident on barium swallow (absent in 85% of individuals), the demonstration of at least three rugal folds traversing the diaphragm is diagnostic of a sliding hiatus hernia [3]. In paraoesophageal hernias there is evidence of the fundus herniating into the mediastinum. On endoscopy a sliding hernia is defined as a greater than 2 cm distance between the squamocolumnar junction and the diaphragmatic impression on the stomach [3]. In paraoesophageal hernias the hernia can be visualised on retroflexion (J manoeuvre) of the endoscope that reveals a portion of the stomach, herniating upward through the diaphragm, adjacent to the endoscope [3]. Another indirect indicator of paraoesophageal hernia that sh...

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Thirty-Day Outcomes of Paraesophageal Hernia Repair Using the NSQIP Database: Should Laparoscopy Be the Standard of Care?

Cited by 65 publications

References 33 publications

Managing obstructive gastric volvulus: challenges and solutions

Managing obstructive gastric volvulus: challenges and solutions

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Paraoesophageal Hernias: A Surgical Perspective

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