Elective versus non-elective surgery in the treatment of giant paraoesophageal hiatal hernia

Introduction

There are few studies comparing elective surgery (ES) and non-elective surgery (NES) in the treatment of giant paraoesophageal hiatal hernia (GPHH). The aim of this study is to analyze and compare the results in terms of morbidity, mortality and recurrences of ES and NES in the treatment of GPHH.

Methods

Retrospective study whose study population consisted of patients with GPHH (types II, III and IV with >30% of the herniated stomach in the thorax) who underwent surgery. Patients with a complete clinical history and a minimum follow-up of 6 months were included. Patients under 15 years old, those with hiatal hernia (HH) type I and those with recurrent HH were excluded. Two groups were compared: patients with GPHH in whom ES was performed and patients with GPHH in whom NES was performed.

Results

The ES group was composed of 31 patients and the NES group of 13 patients. There were no differences in terms of age and sex. Patients in the NES group had a lower percentage of laparoscopic approach (100% vs. 38.5%; P < .001), a higher percentage of complications (9.7% vs. 53.8%; P = .003) and a longer hospital stay (4.8 ± 7.8 vs. 14.3 ± 10.4 days; P < .001). There were no differences between the two groups in terms of recurrence and mortality.

Conclusions

Repair of GPHH by NES presents greater morbidity and hospital stay compared to repair by ES, however, there are no differences in terms of recurrences and mortality.