Urgent Paraesophageal Hernia: Can We Do Better?

Paraesophageal hernia (PEH) is a relatively common pathology in the Western population. It may be asymptomatic, but ∼50% of patients with PEH have symptoms that may mimic gastrointestinal, respiratory, and cardiac pathology. Surgery is recommended in all acute cases of PEH, but indications for surgical intervention in asymptomatic or nonacutely symptomatic patient remain unclear. Purpose of this study was to evaluate our experience in management of patients with PEH admitted to the surgical word. Our special interest was in acute cases of emergency admission who were previously discharged from emergency room (ER). Data of patients who underwent PEH repair from January 1, 2017 to May, 2023, were retrospectively evaluated. Patients were divided into two groups. Group I included patients admitted through ER with acute symptoms of PEH. Patients who underwent elective surgery were included in group II. Group I patients were additionally divided on those who previously visited ER, and signs of PEH were underscored and those who were admitted to ER first time. Ninety-eight patients underwent laparoscopic PEH repair. Group I included 28 patients (28.9%). Significant differences were noticed in patient's age, main complaint, and rate of complications. Fourteen patients from group I were previously discharged from ER, and in 12 of them, imaging study clearly showed diaphragmatic hernia. Patients who underwent elective laparoscopic PEH repair have better outcome. Signs of PEH may be underscored by ER physicians. Higher index of suspicion required to diagnose this relatively rare reason of ER admission.