Feasibility, Outcomes, and Odds of Same-Day Surgery in Laparoscopic Elective Repair of Type IV Hiatal Hernia with Intrathoracic Stomach.

Abstract

To assess the feasibility, outcomes, and odds of same-day surgery (SDS) in the laparoscopic elective primary repair of intrathoracic stomach (ITS). To assess the significance of percentage of intraoperative gastric incarceration in planning SDS. ITS was defined as 100% gastric herniation into the chest on preoperative imaging. The percentage of intraoperative gastric incarceration into the chest was assessed, and patients with partial gastric incarceration were compared with those with 100% incarceration. Planning for SDS started in 2019. From 2012 to 2024, there were 1,057 hiatal hernia repairs and 190 of 1,057 (18%) primary laparoscopic ITS repairs; 8 procedures in which percentage of intraoperative gastric incarceration was not documented were excluded, and 182 procedures were included; 127 of 182 (69.8%) were elective: 58 of 127 (45.7%) had intraoperative partial gastric incarceration and 69 of 127 (54.3%) had 100% incarceration. Since planning for SDS started, there were 56 elective repairs. SDS was planned in 36 of 56 (64.3%) and was performed in 33 of 36 (91.7%). Comparing 33 of 56 (58.9%) procedures performed as SDS to 23 of 56 (41.1%) not performed as SDS showed comparable sex, age, BMI, and American Society of Anesthesiologists class. The operative time was 117 (interquartile range 100 to 144) minutes vs 129 (interquartile range 110 to 167), p = 0.134, emergency department visits were 5 of 33 (15.2%) vs 3 of 23 (13.0%), p = 1.00, and readmissions 4 of 33 (12.1%) vs 1 of 23 (4.3%), p = 0.64. The odds of SDS were comparable for sex, age, BMI, percentage of intraoperative gastric incarceration, and operative time. The percentage of gastric herniation on preoperative imaging does not correlate with the percentage of intraoperative gastric incarceration in about half of patients with ITS. SDS is feasible in the majority of laparoscopic elective ITS repairs and can be performed with good outcomes in patients with intraoperative partial or 100% gastric incarceration.