Emergency surgery for hiatus hernias: does technique affect outcomes? A single-centre experience

Area of Science:

• Gastroenterology
• Surgical Oncology
• Emergency Medicine

Background:

• Emergency surgery for hiatus hernia is high-risk in acutely unwell patients.
• Common techniques include reduction, cruroplasty, fundoplication or gastropexy with gastrostomy.
• This study compares recurrence rates between fundoplication and gastropexy for complicated hiatus hernias.

Purpose of the Study:

• To compare recurrence rates between fundoplication and gastropexy in emergency hiatus hernia repair.
• To evaluate morbidity and mortality associated with these emergency procedures.

Main Methods:

• Retrospective review and analysis of 80 patients undergoing emergency hiatus hernia repair from October 2012 to November 2020.
• Primary outcome: symptomatic recurrence requiring surgical repair.
• Secondary outcomes: morbidity and 30-day mortality.

Main Results:

• Fundoplication was performed in 38% and gastropexy in 53% of patients.
• Eight patients (10%) experienced symptomatic recurrence requiring repair (4 fundoplication, 3 gastropexy, 1 resection).
• 30-day mortality was 7.5%, with respiratory complications being most prevalent.

Conclusions:

• Both fundoplication and gastropexy are safe and effective for emergency hiatus hernia repair, with similar recurrence rates.
• Surgical technique can be tailored to patient characteristics and surgeon experience.
• Emergency hiatus hernia repair is a safe, often life-saving procedure for elderly, comorbid patients.