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Impact of surgical repair on type IV paraesophageal hernias (PEHs)

  • 2021 SAGES Poster
  • Published:
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Abstract

Background

Paraesophageal hernias (PEHs; types II-III-IV) account for about 5% of all hiatal hernias (HHs). The peculiarity of PEHs is the presence of a herniated sac which contains a more or less important part of the stomach, along with other abdominal organs in type IV PEHs. Surgical treatment is more complex since it requires a reduction not only of the herniated content but also of the “container,” namely the sac adherent to mediastinal structures. Since type III and IV PEHs are mostly grouped together as large PEHs, there is a lack of articles in the literature with regards to clear surgical outcomes, as well as management algorithms in type IV PEHs. This study aims to compare outcomes in type IV vs. type III PEHs after surgical repair.

Methods

A retrospective study of patients who underwent laparoscopic PEH hernia repair (LPEHR) was conducted in a single institution between 2006 and 2020. Patient baseline characteristics and surgical outcomes were analyzed.

Results

A total of 103 patients were included in the analysis. Patients presenting with type IV PEHs (12/103) were significantly older than patients with type III PEHs (91/104) (75.25 ± 7.15 vs. 66.91 ± 13.58 respectively (p = 0.039), and more fragile with a higher Charlson Comorbidity Index (CCI) (4.25 ± 1.48 vs. 2.96 ± 1.72, p = 0.016). Operative time was significantly longer (243 ± 101.73 vs. 133.38 ± 61.76, p = 0.002), and postoperative morbidity was significantly higher in type IV PEH repair (50% vs. 8.8% type III, p = 0.000).

Conclusion

Patients with type IV PEHs appear to be older and frailer. The higher incidence of postoperative complications in patients with type IV PEHs should advocate for a precise indication for surgical treatment, which should be performed in centers of expertise.

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Acknowledgements

The authors are grateful to Guy Temporal, professional in medical English proofreading for his valuable assistance with manuscript revision.

Funding

No funding was provided for this study.

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Authors and Affiliations

  1. Research Institute against Digestive Cancer (IRCAD), 1, place de l’Hôpital, 67000, Strasbourg, France

    María Rita Rodríguez-Luna, Jacques Marrescaux, Bernard Dallemagne & Silvana Perretta

  2. ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France

    María Rita Rodríguez-Luna & Margherita Pizzicannella

  3. Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France

    Margherita Pizzicannella, Abdullah Almuttawa, Alfonso Lapergola, Didier Mutter, Bernard Dallemagne & Silvana Perretta

  4. Fondazione Policlinico Universitario A. Gemelli IRCCS, 8 Largo A. Gemelli, 0016, Rome, Italy

    Claudio Fiorillo

  5. Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia

    Abdullah Almuttawa

  6. IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France

    Silvana Perretta

Authors
  1. María Rita Rodríguez-Luna
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  2. Margherita Pizzicannella
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  3. Claudio Fiorillo
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  4. Abdullah Almuttawa
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  5. Alfonso Lapergola
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  7. Jacques Marrescaux
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  8. Bernard Dallemagne
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  9. Silvana Perretta
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Correspondence to María Rita Rodríguez-Luna.

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Disclosures

Jacques Marescaux is the President of IRCAD, who is partly funded by KARL STORZ and Medtronic. María Rita Rodríguez-Luna, Margherita Pizzicannella, Claudio Fiorillo, Abdullah Almuttawa, Alfonso Lapergola, Didier Mutter, Bernard Dallemagne, and Silvana Perretta have no conflicts of interest or financial ties to disclose.

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Rodríguez-Luna, M.R., Pizzicannella, M., Fiorillo, C. et al. Impact of surgical repair on type IV paraesophageal hernias (PEHs). Surg Endosc 36, 5467–5475 (2022). https://doi.org/10.1007/s00464-021-08828-w

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  • DOI: https://doi.org/10.1007/s00464-021-08828-w

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