Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Whealon, Matthew D.; Blondet, Juan J.; Gahagan, John V.; Phelan, Michael; Nguyen, Ninh T.

doi:10.1007/s00464-017-5482-4

Cited by 13 publications

(7 citation statements)

References 31 publications

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“…A review of the National Inpatient Sample database between 2008 and 2012 analyzed a total of 31,228 laparoscopic diaphragmatic hernia operations [ 71 ]. Pediatric, emergent, and open cases were excluded.…”

Section: Resultsmentioning

confidence: 99%

“…Pediatric, emergent, and open cases were excluded. The overall in-hospital mortality was 0.14% [ 71 ]. Using 10 cases per year as the volume threshold, low-volume hospitals had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs 0.12%, respectively, p = 0.02).…”

Section: Resultsmentioning

confidence: 99%

“…Using 10 cases per year as the volume threshold, low-volume hospitals had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs 0.12%, respectively, p = 0.02). The authors concluded that there was a small but significant inverse relationship between the hospital’s case volume and mortality in laparoscopic diaphragmatic hernia repair [ 71 ].…”

Section: Resultsmentioning

confidence: 99%

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Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

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Introduction There is a need for hernia centers and specialist hernia surgeons because of the increasing complexity of hernia surgery procedures due to new techniques, more difficult cases and a tailored approach with an increasing public awareness demanding optimal treatment results. Therefore, the requirements for accredited/certified hernia centers and specialist hernia surgeons should be formulated by the international and national hernia societies, while taking account of the respective health care systems. Methods The European Hernia Society (EHS) has appointed a working group composed of 18 hernia experts from all regions of Europe (ACCESS Group—Hernia Accreditation and Certification of Centers and Surgeons—Working Group) to formulate scientifically based requirements for hernia centers and specialist hernia surgeons while taking into consideration different health care systems. A consensus was reached on the key questions by means of a meeting, a telephone conference and the exchange of contributions. The requirements formulated below were deemed implementable by all participating hernia experts in their respective countries. Results The ACCESS Group suggests for an adequately equipped hernia center the following requirements: (a) to be accredited/certified by a national or international hernia society, (b) to perform a higher case volume in all types of hernia surgery compared to an average general surgery department in their country, (c) to be staffed by experienced hernia surgeons who are beyond the learning curve for all types of hernia surgery recommended in the guidelines and are responsible for education and training of hernia surgery in their department, (d) to treat hernia patients according to the current guidelines and scientific recommendations, (e) to document each case prospectively in a registry or quality assurance database (f) to perform follow-up for comparison of their own results with benchmark data for continuous improvement of their treatment results and ensuring contribution to research in hernia treatment. To become a specialist hernia surgeon, the ACCESS Group suggests a general surgeon to master the learning curve of all open and laparo-endoscopic hernia procedures recommended in the guidelines, perform a high caseload and additionally to implement and fulfill the other requirements for a hernia center. Conclusion Based on the above requirements formulated by the European Hernia Society for accredited/certified hernia centers and hernia specialist surgeons, the national and international hernia societies can now develop their own programs, while taking account of their specific health care systems.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

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“…In case of post-operative symptoms such as dysphagia, or suspicion of other complications, contrast studies can be undertaken and revisional surgery can safely be undertaken laparoscopically. Primary as well as revisional surgery of hiatal hernias by experienced surgeons in high volume centers, has shown a small but significant inverse relationship between the hospitals' case volume and mortality [25].…”

Section: Editorialmentioning

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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“…Additionally, hospitals performing less that 10 cases per year had double the mortality of high-volume hospitals. 14 The recurrent PEH requiring reoperation represents additional complexity and operative risk, but further centralization of care should provide consistent symptom improvement while maintaining excellent outcomes. Lovece et al reported their results recently and demonstrated nearly a 20 point improvement in quality of life scores with no patients needing revisional surgery at 56 months follow-up.…”

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confidence: 99%

Indications for Repair of Minimally Symptomatic Paraesophageal Hernia: A Surgical Perspective

Buckley

Hill

Furay

2022

Foregut: The Journal of the American Foregut Society

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Paraesophageal hernias (PEH) represent a minority of hiatal hernias and yet have the highest potential for catastrophic consequences for patients. Patients with paraesophageal hernias tend to be older with more comorbidities. The risk to benefit calculation in the treatment of patients with a minimally symptomatic PEH can complicated. Surgical repair and management of hiatal hernias has come a long way since the first repairs were undertaken. Surgical risk has become minimal, while gains in quality of life have increased. Decisions for surgery should be undertaken by well informed patients who have benefited from consultation with a gastroenterologist and foregut surgeon. For most patients suffering with a symptomatic PEH, the risk benefit calculation has swung firmly toward surgical repair when a multi-specialty approach is taken.

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Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Cited by 13 publications

References 31 publications

Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project

Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project

Paraoesophageal Hernias: A Surgical Perspective

Indications for Repair of Minimally Symptomatic Paraesophageal Hernia: A Surgical Perspective

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