Paraesophageal Hernia
- Incarcerated paraesophageal hernia and gastric volvulus: Management options for the acute care surgeon, an Eastern Association for the Surgery of Trauma master class video presentation.
- Coleman C, Musgrove K, Bardes J, Dhamija A, Buenaventura P, Ghulam A, Wilson A, Grabo D.
- J Trauma Acute Care Surg . 2020 Jun;88(6):e146-e148.
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Rationale for inclusion: EAST master class video presentation providing instruction acute care surgeon management of the incarcerated paraesophageal hernia. Provides recommendations on initial management, as well as detailed, cadaver-based instruction for operative management.
CAVEAT: Expert opinion.Citations - To review the number of citations for this landmark paper, visit Google Scholar.
- Non-Elective Paraesophageal Hernia Repair Portends Worse Outcomes in Comparable Patients: a Propensity-Adjusted Analysis.
- Tam V, Luketich JD, Winger DG, Sarkaria IS, Levy RM, Christie NA, Awais O, Shende MR, Nason KS.
- J Gastrointest Surg . 2017 Jan;21(1):137-145.
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Rationale for inclusion: Retrospective review of prospectively collected data including 980 patients who underwent paraesophageal hernia repair, attempting to determine whether non-elective repair is associated with different postoperative outcomes using propensity-score weighting. This was largely driven by the fact most non-elective repairs are performed in the elderly, who have more adverse prognostic factors and increased risk of major complication. After adjusting propensity-weighted data for age and comorbidity score, odds of major morbidity (OR 1.67) and mortality (OR 2.74) were significantly higher in non-elective repair, suggesting all symptomatic patients should be referred for discussion of elective repair.
CAVEAT: Single institution.Citations - To review the number of citations for this landmark paper, visit Google Scholar.
- A population-based analysis of emergent versus elective paraesophageal hernia repair using the Nationwide Inpatient Sample.
- Jassim H, Seligman JT, Frelich M, Goldbatt M, Kastenmeier A, Wallace J, Zhao HS, Szabo A, Gould JC.
- Surg Endosc . 2014 Dec;28(12):3473-8.
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Rationale for inclusion: Large outcomes analysis from the Nationwide Inpatient Sample (n=8,462), demonstrating significantly higher rate of morbidity (33.4 vs 16.5%) and mortality (3.2 vs 0.37%) comparing emergent and elective repair. Furthermore, supports the decreased morbidity and mortality associated with laparoscopic repair, regardless of circumstances of repair.
CAVEAT: Database study, potentially underestimating frequency of major morbidity and mortality. Additionally, analysis includes all repairs, regardless of indication (GERD vs type 4 PEHR.)Citations - To review the number of citations for this landmark paper, visit Google Scholar.
- Wait only to resuscitate: early surgery for acutely presenting paraesophageal hernias yields better outcomes.
- Bhayani NH, Kurian AA, Sharata AM, Reavis KM, Dunst CM, Swanstorm LL.
- Surg Endosc . 2013 Jan;27(1):267-71.
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Rationale for inclusion: NSQIP analysis including patients undergoing surgery for obstructed paraesophgeal hernia, comparing early (first hospital day) vs delayed inpatient repair, indicating similar morbidity and mortality. Occurrence of sepsis and length of stay were significantly reduced in the early group, suggesting benefit in these specific complications if surgery can proceed safely if performed early. Mortality, however, was not statistically increased if surgery was delayed, suggesting relative safety of preoperative resuscitation and decompression with interval repair.
CAVEAT: Database study, potentially underestimating frequency of major morbidity and mortality.Citations - To review the number of citations for this landmark paper, visit Google Scholar.
- Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair - A multicenter, prospective, randomized trial.
- Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M. Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L.
- Ann Surg . 2006 Oct;244(4):481-90.
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Rationale for inclusion: Multicenter randomized trial comparing primary paraesophgeal hernia repair and primary repair with mesh buttress, demonstrating significant reduction in hernia recurrence at 6 months (9 vs 24%). Importantly, no mesh-related complications or side effects were identified, indicating safety and improved short-term outcome.
CAVEAT: Relatively small MCT without long-term outcome data.. 2006 Oct;244(4):481-90.
Citations - To review the number of citations for this landmark paper, visit Google Scholar.