From the Journals

Fewer complications, lower mortality with minimally invasive hernia repair

 

Key clinical point: Minimally invasive surgery for paraesophageal hernia repair is associated with significantly lower in-hospital mortality and complication rates than open repair.

Major finding: Compared with open-repair procedures, minimally invasive paraesophageal hernia repair was associated with significantly lower in-hospital mortality, wound, septic, bleeding, urinary, respiratory, and cardiac complications, and intraoperative injury.

Data source: A retrospective review of 97,393 inpatient admissions for paraesophageal hernia repair between 2002 and 2012.

Disclosures: The study was funded by the Oregon Clinical and Translational Research Institute and the National Center for Advancing Translational Sciences of the National Institutes of Health. No conflicts of interest were declared.


 

FROM JAMA SURGERY

Minimally invasive surgical techniques are now used in nearly 80% of operations for paraesophageal hernia repair (PEH) and are associated with many outcome improvements, in comparison with open surgery, according to a retrospective study of data from nearly 100,000 cases.

Surgery being performed Dmitrii Kotin/Thinkstock.com
The authors did a retrospective study of 97,393 inpatient admissions for paraesophageal hernia repair, taken from the Nationwide Inpatient Sample between 2002 and 2012 (JAMA Surgery 2017, Aug 23. doi: 10.1001/jamasurg.2017.2868).

They found that the proportion of repair conducted using minimally invasive techniques increased from 9.8% in 2002 to 79.6% in 2012. At the same time, in-hospital mortality associated with paraesophageal hernia repair declined from 3.5% to 1.2%, and the rates of complications dropped from 29.8% to 20.6%.

Compared with open-repair procedures, minimally invasive surgery was associated with significantly lower in-hospital mortality (0.6% vs. 3%; P less than .001); wound complications (0.4% vs. 2.9%; P less than .001); septic complications (0.9% vs. 3.9%; P less than .001); and bleeding complications (0.6% vs. 1.8%; P less than .001), as well as urinary, respiratory, and cardiac complications, and intraoperative injury. No significant differences were seen between the two groups in the incidence of thromboembolic complications.

The mean length of hospital stay was 4.2 days in patients who underwent surgery using minimally invasive techniques, compared with 8.5 days in those who had open surgery.

The authors noted that early research on MIS for PEH raised the question of a possible higher risk of recurrence. While the study did not examine the incidence of hernia recurrence, the authors cited data showing that improvements in minimally invasive surgical techniques have been linked to a reduction in hiatal hernia recurrences.

“Studies have found that recurrences requiring reoperation after MIS repairs are low at 2.2%-6%,” the authors wrote. “Regardless, a role remains for open PEH repairs in cases of multiple prior abdominal operations and acute strangulation and in patients with an unstable condition.”

The study was funded by the Oregon Clinical and Translational Research Institute and the National Center for Advancing Translational Sciences of the National Institutes of Health. No conflicts of interest were declared.

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