PD03.06. Operative Repair of Post-Esophagectomy Hiatal Hernias is Associated with Higher Morbidity than Paraesophageal Hernias

Abstract

Benign Disease: Esophageal Surgery Post-esophagectomy hiatal hernias (PEHHs) are infrequent complications of esophagectomies. Their incidence is likely underestimated and ranges from 1-6%. Outcomes of PEHHs compared to paraesophageal hernias (PEHs) are limited in the literature. This study aimed to compare outcomes of operative repairs of PEHHs to PEHs. This was a single-center IRB-approved retrospective review of hiatal hernia repairs after Ivor Lewis esophagectomies (PEHHs) and type II toIV PEHs from 2013 to 2024. Primary outcomes were length of stay (LOS), and 90-day readmission, reoperation, and mortality. Descriptive statistics and a univariable logistic regression model (odds ratio; 95% confidence interval; p-value) were used. The incidence of PEHHs in our study was 5.0% (n=16/321). Given that all PEHHs contained additional viscera, a subgroup analysis was performed to compare PEHHs to type IV PEHs. Thirteen patients underwent PEHH repair, and 207 patients underwent a type II-IV PEH repair at our institution (Table 1). Notably, 62% of PEHH patients required an urgent procedure for acute incarceration, compared with 10% in the PEH cohort (OR 14.2; 95% CI 4.2-47.3; p<0.01). An open operation was more common in the PEHH cohort (23% vs 3%; OR 10.1; 95% CI 2.2-46.2, p=0.003) with shorter operative times (p=0.001). In the PEHH cohort, LOS was longer (OR 1.1; 95% CI 1.0-1.2; p=0.03). Overall, 90-day readmissions (p=0.58) and reoperations (p=0.60) were similar. There was one death in each cohort (p=0.05). On subgroup analysis, PEHHs were still more likely to require an urgent operation compared with type IV PEHs (62% vs 20%; p<0.01. Table 2). These operations were more likely to be performed open (p<0.01), with a longer operative time (p<0.01) and an increased LOS (p<0.01). Readmissions (p=0.74) and reoperations (p=0.50) were similar. PEHHs, though infrequent, are more likely to present acutely, requiring an urgent repair compared with PEHs. Additionally, PEHHs are more likely to require an open operation and are associated with a longer length of stay, even when compared with type IV PEHs, which was statistically significant. In surgical candidates, early, elective repair of PEHHs could potentially reduce perioperative morbidity. Prospective studies with larger patient cohorts are needed to validate these findings.