Skip to main content
SpringerLink
Log in

Minimally invasive approach to hiatal hernia repair is superior to open, even in the emergent setting: a large national database analysis

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

We aimed to examine the outcomes and utilization of different hiatal hernia repair (HHR) approaches in elective and emergent/urgent settings. Methods: Vizient 2015–2017 database was queried for adult patients who underwent HHR. Patients were grouped into open (OHHR), laparoscopic (LHHR), or robotic-assisted (RHHR), and further stratified by elective or urgent status and severity of illness at admission. Surgical outcomes and costs were compared across all groups. Statistical analysis were done using SPSS v.25.0.

Results

9171 adults were included (OHHR N = 1534;LHHR N = 6796;RHHR N = 841). LHHR was the most utilized approach (74.1%), followed by OHRR (16.7%) and RHHR (9.2%). OHHR was employed three times as frequently in U settings, compared to elective. Overall, OHHR had longer mean length of stay (LOS; 9.41 vs. < 4 days) and higher postoperative complication rates (8.8% vs < 3.8%), mortality (2.7% vs < 0.5%) and mean direct cost ($27,842 vs < $10,407), when compared to both LHHR and RHHR, all p < 0.05. Analysis of mild to severely ill elective cases demonstrated LHHR and RHHR to be better than OHHR regarding complications (p < 0.05), cost (p < 0.001) and LOS (p < 0.013); there were insufficient extremely ill elective patients for meaningful analysis. In the urgent setting, minimally invasive approaches predominate, overtaken by OHHR only for the extremely ill. Despite the urgent setting, for mild-moderately ill patients, OHHR was statistically inferior to both LHHR and RHHR for LOS (p = 0.002, p < 0.0001) and cost (p = 0.0133, p < 0.001). In severe-extremely ill patients, despite being more utilized, OHHR was not superior to LHHR; in fact, complication, cost, and mortality trends (all p > 0.05) favored LHHR.

Conclusion

Our analysis demonstrated LHHR to currently be the most employed approach overall. LHHR and RHHR were associated with lower cost, decreased LOS, complications, and mortality compared to OHHR, in all but the sickest of patients. Patients should be offered minimally invasive HHR, even in urgent/emergent settings, if technically feasible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dallemagne B, Quero G, Lapergola A, Guerriero L, Fiorillo C, Perretta S (2018) Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia 22(6):909–919

    Article  CAS  Google Scholar 

  2. Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236(4):492–500

    Article  Google Scholar 

  3. Pokala B, Armijo PR, Flores L, Hennings D, Oleynikov D (2019) Minimally invasive inguinal hernia repair is superior to open: a national database review. Hernia 23(3):593–599

    Article  CAS  Google Scholar 

  4. Paul S, Nasar A, Port JL et al (2012) Comparative analysis of diaphragmatic hernia repair outcomes using the nationwide inpatient sample database. Arch Surg 147(7):607–612

    Article  Google Scholar 

  5. Jassim H, Seligman JT, Frelich M et al (2014) A population-based analysis of emergent versus elective paraesophageal hernia repair using the nationwide inpatient sample. Surg Endosc 28(12):3473–3478

    Article  Google Scholar 

  6. Vasudevan V, Reusche R, Nelson E, Kaza S (2018) Robotic paraesophageal hernia repair: a single-center experience and systematic review. J Robot Surg 12(1):81–86

    Article  Google Scholar 

  7. Armijo P, Pratap A, Wang Y, Shostrom V, Oleynikov D (2018) Robotic ventral hernia repair is not superior to laparoscopic: a national database review. Surg Endosc 32(4):1834–1839

    Article  Google Scholar 

  8. Pokala B, Flores L, Armijo PR, Kothari V, Oleynikov D (2019) Robot-assisted cholecystectomy is a safe but costly approach: a national database review. Am J Surg 218(6):1213–1218

    Article  Google Scholar 

  9. Fullum TM, Oyetunji TA, Ortega G et al (2013) Open versus laparoscopic hiatal hernia repair. JSLS 17(1):23–29

    Article  Google Scholar 

  10. Ferri LE, Feldman LS, Stanbridge D, Mayrand S, Stein L, Fried GM (2005) Should laparoscopic paraesophageal hernia repair be abandoned in favor of the open approach? Surg Endosc 19(1):4–8

    Article  CAS  Google Scholar 

  11. Seetharamaiah R, Romero RJ, Kosanovic R et al (2013) Robotic repair of giant paraesophageal hernias. JSLS 17(4):570–577

    Article  Google Scholar 

  12. Tolboom RC, Draaisma WA, Broeders IA (2016) Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study. J Robot Surg 10(1):33–39

    Article  Google Scholar 

  13. Vasudevan V, Kichler K, De La Cruz L, Kaza S (2014) Retrospective comparative analysis of robotic versus laparoscopic paraesophageal hernia repair: a single center experience. https://www.sages.org/meetings/annual-meeting/abstracts-archive/retrospective-comparative-analysis-of-robotic-versus-laparoscopic-paraesophageal-hernia-repair-a-single-center-experience/, Accessed 1 Aug 2019.

Download references

Author information

Authors and Affiliations

  1. Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA

    Salim Hosein, Laura Flores, Priscila Rodrigues Armijo & Dmitry Oleynikov

  2. Department of Surgery, General Surgery, University of Nebraska Medical Center, Omaha, NE, USA

    Salim Hosein, Priscila Rodrigues Armijo & Dmitry Oleynikov

  3. College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    Tyson Carlson

  4. Minimally Invasive and Bariatric Surgery, Department of General Surgery, University of Nebraska Medical Center, 986246 Nebraska Medical Center, Omaha, NE, 68198-6246, USA

    Dmitry Oleynikov

Authors
  1. Salim Hosein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tyson Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Flores
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Priscila Rodrigues Armijo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dmitry Oleynikov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dmitry Oleynikov.

Ethics declarations

Conflict of interest

Dmitry Oleynikov is stockholder of Virtual Incision Corporation. Salim Hosein, Tyson Carlson, Laura Flores, and Priscila Rodrigues Armijo declare that they have no conflicts of interest.

Disclosures

Dr. Oleynikov is stockholder of Virtual Incision Corporation. Dr. Hosein, Mr. Carlson, Ms. Flores, and Dr. Armijo have nothing to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Address for Dr. Dmitry Oleynikov and Dr. Salim Hosein reflect the address at the time the study was performed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hosein, S., Carlson, T., Flores, L. et al. Minimally invasive approach to hiatal hernia repair is superior to open, even in the emergent setting: a large national database analysis. Surg Endosc 35, 423–428 (2021). https://doi.org/10.1007/s00464-020-07404-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07404-y

Keywords

Search

Navigation