Urgent vs elective surgical repair in large paraesophageal hernia: a matched case-control study

Surgical repair of large type III/IV paraesophageal hernia (PEH) is challenging especially in the presence of acute gastric volvulus (AGV). This study compared postoperative complications (POCs) and 30-day mortality between urgent and elective PEH repair.

Between 2007 and 2024, a matched case-control study was conducted in a tertiary care hospital in Barcelona, Spain. Patients undergoing PEH repair on an emergency basis or electively were matched (1:1) by age and sex (male/female). Cases were patients with AGV requiring urgent or semielective repair, whereas controls were patients with type III/IV scheduled for elective surgery. POC was the primary outcome variable.

A total of 74 patients (37 cases and 37 controls) were analyzed. The mean age was 78.0 years (SD, 8.9). Cases and controls showed similar American Society of Anesthesiologists and modified frailty index scores, but the Charlson comorbidity index score was higher in the urgent group. Cases showed longer duration of surgery than controls (223 [68.4] vs 194 [45.9] minutes; P =.03), postoperative length of hospital stay (13.2 [13.8] vs 4.9 [4.1] days; P =.0008), and need of open or converted procedures (odds ratio [OR], 8.4; P =.008). Urgent surgery was an independent factor for POCs (OR, 7.4; P =.0001). Reoperation rates were unrelated to the type of surgery. Mortality was low (only elective cases), with comparable 90-day readmissions and recurrences between cases and controls.

In this case-control study, urgent repair of complex PEH showed higher POC than elective surgery but 30-day mortality and readmission rates were similar.