Urgent Paraesophageal Hernia: Can We Do Better?

Area of Science:

• Gastroenterology
• Surgical Pathology
• Medical Diagnostics

Background:

• Paraesophageal hernia (PEH) is a common condition with symptoms mimicking other pathologies.
• Surgical intervention is standard for acute PEH, but indications for elective surgery remain debated.
• Emergency room (ER) physicians may overlook PEH signs, leading to delayed diagnosis and treatment.

Purpose of the Study:

• To evaluate the management of patients with paraesophageal hernia (PEH).
• To analyze outcomes of acute PEH cases, particularly those previously discharged from the ER.
• To highlight the importance of diagnosing PEH in emergency settings.

Main Methods:

• Retrospective analysis of 98 patients undergoing laparoscopic PEH repair (January 2017 - May 2023).
• Patients divided into acute (ER admission) and elective surgery groups.
• Subgroup analysis of acute cases based on prior ER visits and missed PEH diagnosis.

Main Results:

• 28 patients (28.9%) were in the acute PEH group (Group I).
• Significant differences in age, symptoms, and complications were observed between groups.
• 14 acute patients had prior ER visits; 12 had imaging showing PEH, indicating missed diagnosis.

Conclusions:

• Elective laparoscopic PEH repair is associated with better patient outcomes.
• Emergency physicians may underestimate PEH, necessitating a higher index of suspicion.
• Accurate and timely diagnosis of PEH is critical for effective ER management.