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Updated: Aug 22, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Timing matters: a comparative analysis of semi-elective, elective, and emergent laparoscopic paraesophageal hernia
Alex I Halpern1, Allison Etcheverry2, Jessie S Frank2
1Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Avenue, Suite 6B, Washington, DC, 20037, USA. alexhalpern@gwu.edu.
Background:
Patients with paraesophageal hernias (PEH) who present with obstruction or other acute symptoms are generally treated with one of three approaches: emergent repair, discharge after stabilization with subsequent elective repair, or "semi-elective repair," defined as elective repair performed during the same hospitalization for acute symptoms but at least one day post-admission. Outcomes associated with semi-elective repair are not well established in the literature. To help address this gap, we evaluated 30-day postoperative outcomes following semi-elective laparoscopic PEH repair and compared them with outcomes following elective and emergent PEH repair.
Methods:
We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients undergoing elective, semi-elective, and emergent laparoscopic PEH repair from 2011 to 2020. Procedures resulting in conversion to open surgery or those requiring resection were excluded. We evaluated 30-day postoperative outcomes using multivariable linear and logistic regression, as well as propensity score matched analyses.
Results:
A total of 34,617 patients underwent elective laparoscopic PEH repair, 2,304 underwent semi-elective PEH repair, and 809 underwent emergent PEH repair. Compared to elective repair, semi-elective PEH repair was independently associated with significantly higher rates of transfusion, deep venous thrombosis/thrombophlebitis, pneumonia/pulmonary embolism, surgical site infection, sepsis/septic shock, readmission, increased length of stay, and increased operative time (all p < 0.001). When compared to emergent repair, semi-elective repair was independently associated with a decreased rate of sepsis/septic shock (p = 0.003).
Conclusions:
Semi-elective laparoscopic PEH repair is associated with higher postoperative morbidity compared with elective repair, but improved outcomes compared to emergent repair. While semi-elective repair following inpatient stabilization may still be necessary for some patients with acute PEH symptoms, temporizing measures with a planned staged repair should be considered whenever feasible.
