Emergent laparoscopic paraesophageal hernia repairs are associated with an increased risk of 30-day post-operative complications: a NSQIP analysis

Document Type

Journal Article

Publication Date

9-8-2025

Journal

Surgical endoscopy

DOI

10.1007/s00464-025-12129-x

Keywords

Complications; Elective; Emergent; NSQIP; Paraesophageal hernia

Abstract

BACKGROUND: Paraesophageal hernias exhibit diverse anatomical variations, and while elective repair is standard for symptomatic cases, larger Types II-IV hernias can necessitate emergent intervention. Despite a recognized demographic trend in emergent cases, a consensus on post-operative outcomes is lacking. This study aims to assess the 30-day post-operative outcomes of elective and emergent laparoscopic paraesophageal hernia (PEH) repair. METHODS: This analysis queried the ACS-NSQIP database from 2011 to 2020, focusing on elective and emergent laparoscopic PEH repairs. Procedures resulting in any resection or conversion to open were excluded. A propensity score matching analysis with a 1:4 ratio was conducted to assess 30-day post-operative outcomes between elective and emergent laparoscopic paraesophageal hernia repair. Additional sensitivity analyses across multiple matching ratios (1:1 to 1:6) and multivariable logistic regression were performed to evaluate the robustness of the initial findings. RESULTS: Eight hundred and four patients underwent emergent laparoscopic PEH repair and 36,926 patients underwent elective repair. Patients who underwent emergent repair were significantly older (p < 0.0001) with lower BMI (p < 0.0001). On propensity score-matched analysis, emergent cases were associated with a significantly higher risk of sepsis (p < 0.0001), infection (p = .0030), transfusion (p < 0.0001), reoperation (p = .0020), longer length of stay (p < 0.0001), pulmonary complications (p < 0.0001), and renal complications (p = .0002). CONCLUSION: Despite the existing literature's discordant findings, our study showed that emergent laparoscopic PEH repairs are associated with significantly worse 30-day outcomes compared to elective laparoscopic PEH repairs. The higher rates of post-operative complications in emergent cases emphasize the need for careful patient selection and procedural planning. Temporizing measures with planned staged repair can be considered a potential strategy in emergent cases.

Department

Surgery

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