Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?
Autor: | Dmitry Oleynikov, Jace J. Heiden, Daniel Lomelin, Jennifer Jolley, Michael Klinginsmith, Crystal Krause |
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Rok vydání: | 2015 |
Předmět: |
Adult
Male Laparoscopic surgery medicine.medical_specialty Paraesophageal Databases Factual medicine.medical_treatment Fundoplication 03 medical and health sciences 0302 clinical medicine medicine Humans Hernia Practice Patterns Physicians' Elective surgery Laparoscopy Herniorrhaphy Aged Retrospective Studies Aged 80 and over Academic Medical Centers medicine.diagnostic_test business.industry General surgery Middle Aged medicine.disease Hernia repair United States Surgery Hernia Hiatal Elective Surgical Procedures 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Emergencies Elective Surgical Procedure business Abdominal surgery |
Zdroj: | Surgical Endoscopy. 30:1790-1795 |
ISSN: | 1432-2218 0930-2794 |
DOI: | 10.1007/s00464-015-4447-8 |
Popis: | Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. We demonstrate that laparoscopic PEH repair has become accepted in emergent cases. Open PEH repair is often reserved for emergent surgeries and less commonly includes an AR procedure. Laparoscopy with an AR procedure is clearly the standard of care in elective surgery. The decision to perform an open or laparoscopic surgery, with or without adjunctive techniques, may be based more on the physician’s comfort with laparoscopic surgery and surgical practices than the patient’s condition. Long-term follow-up studies are needed to determine the functional outcomes of these strategies. |
Databáze: | OpenAIRE |
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