Fundoplication vs. gastric fixation for the management of emergency hiatal hernia repairs: aretrospective cohort study.

Abstract

There is a paucity of literature comparing safety outcomes between formal fundoplication and gastric fixationproceduresfor hiatal hernia repairs, especially in the emergency setting. The objective of this study was to evaluate 30-day clinicaloutcomes between fundoplication and gastric fixation performed in emergency hiatal hernia repairs. A retrospective cohort study using the National Surgery Quality Improvement Program(NSQIP) database from 2011 to 2021 was conducted. The study population was determined usingICD9/10 codes describing diaphragmatic hernia without obstruction or gangrene, with obstruction,and with gangrene. Elective cases were excluded. CPT codes were used to group fundoplicationprocedures and gastric fixation procedures. The primary outcome was the 30-day complication rate. Secondary outcomes included 30-day readmission, reoperation and mortalityrates. A multivariablelogistic regression analysiswas used to adjust for clinically relevant confounding variables. A total of 971 and 346 were in the fundoplication and gastric fixation groups, respectively.Fundoplication was associated with a significantly lower (p < 0.05) 30-day complication, reoperation and mortality rates. There was no statistically significantdifference with respect to readmission. After adjustment, fundoplication was significantlyassociated with a decrease in odds of 30-day complications (OR 0.53,p < 0.001 95% CI0.40-0.71) and mortality (OR 0.55,p = 0.033 95% CI 0.32-0.95). However, there was nosignificant difference with respect to 30-day readmission (OR 0.86,p = 0.449 95%CI 0.59-1.27) and reoperation (OR 0.66,p = 0.063 95% CI 0.42-1.02). Patients with hiatal hernias that underwent emergent repair with fundoplication had asignificantly lower 30-day complication and mortality rates compared to those who underwent gastricfixation procedures. Fundoplication is a safe and feasible approach to manage hiatal hernias in the emergency setting for select patients.