Do Poor Functional Outcomes and Higher Morbidity Following Emergency Repair of Giant Hiatus Hernia Warrant Elective Surgery in Asymptomatic Patients?

Iulia Bujoreanu,Ravindra Date,Savvas Lampridis,Daniya Abrar

doi:10.3389/fsurg.2021.628477

Abstract

Background: Patients with a giant hiatus hernia may present with acute symptoms caused by obstruction, strangulation, perforation and uncontrolled bleeding. Emergency surgical repair has been associated with significant mortality and even greater morbidity. The aim of this study is to investigate the short-term outcomes following emergency repair of giant hiatus hernias.Methods: Data were retrospectively collected for all patients who underwent emergency surgical repair of giant hiatus hernia in a university teaching hospital between 2009 and 2019. Outcomes were short-term morbidity and mortality. We also assessed the association of clinical predictor covariates, including age, ASA class and time to surgery, with risk for major morbidity.Results: Thirty-seven patients with a median age of 68 years were identified. Following surgery, 9 patients (24.3%) developed organ dysfunction that required admission to the intensive care unit. Two patients (5.4%) underwent revision surgery and 3 (8.1%) developed pneumothorax that necessitated chest drain insertion. The commonest complication was pneumonia, which occurred in 13 patients (35.1%). Two deaths (5.4%) occurred within 30 days from surgery.Conclusions: Emergency repair of giant hiatus hernia is associated with high rates of major morbidity, which includes poor functional status, further interventions, repeat surgery, and admission to the intensive care unit. Larger studies are warranted for long-term follow-up to assess post-operative quality of life is needed for asymptomatic patients and for those undergoing emergency surgery.

Highlights

Since centralization of Upper Gastro-Intestinal cancer services in 2009, exponential growth in referrals for oesophago-gastric emergencies such as esophageal perforations and incarcerated giant hiatus hernias (GHH) was noted
Aim of this study is to present the short-term outcomes of non-elective GHH repair in a single institution over a 10-year period, review the pertinent literature and provide insights into decisions for asymptomatic patients
Similar were the findings in other studies, in which patients presenting acutely were older and had higher prevalence of at least one cardiopulmonary comorbidity compared to those undergoing elective GHH repair [17,18,19]

Summary

Introduction

Since centralization of Upper Gastro-Intestinal cancer services in 2009, exponential growth in referrals for oesophago-gastric emergencies such as esophageal perforations and incarcerated giant hiatus hernias (GHH) was noted. This tertiary referral unit maintains prospective data of all the giant hernias (>30% stomach in chest), that undergo elective as well as emergency surgery. The risk of developing acute symptoms that necessitate emergency surgery is estimated between 0.7 and 7% [7] Despite this relatively low incidence, clinicians must be mindful of these patients, as the mortality rate of emergency surgery ranges from 7 to 50%, which is much higher than that of elective repair (0.65%) [8, 9]. The aim of this study is to investigate the short-term outcomes following emergency repair of giant hiatus hernias

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Discussion

Conclusion