INTRODUCTION Elective repair versus watchful waiting remains controversial in paraesophageal hernia (PEH) patients. Generation of predictive factors to determine patients at greatest risk for emergent repair may prove helpful. The aim of this study was to evaluate patients undergoing elective versus emergent PEH repair and supplement this comparison with 3D volumetric analysis of hiatal defect area (HDA) and intrathoracic hernia sac volume (HSV) to determine risk factors for increased likelihood of emergent repair. METHODS A retrospective review of a prospectively enrolled, single-center hernia database was performed on all patients undergoing elective and emergent PEH repairs. Patients with adequate preoperative computed tomography (CT) imaging were analyzed using volumetric analysis software. RESULTS Of the 376 PEH patients, 32 (8.5%) were emergent. Emergent patients had lower rates of preoperative heartburn (68.8%vs85.1%, p = 0.016) and regurgitation (21.9%vs40.2%, p = 0.04), with similar rates of other symptoms. Emergent patients more frequently had type IV PEHs (43.8%vs13.5%, p < 0.001). Volumetric analysis was performed on 201 patients, and emergent patients had a larger HSV (805.6 ± 483.5vs398.0 ± 353.1cm3, p < 0.001) and HDA (41.7 ± 19.5vs26.5 ± 14.7 cm2, p < 0.001). In multivariate analysis, HSV increase of 100cm3 (OR 1.17 CI 1.02-1.35, p = 0.022) was independently associated with greater likelihood of emergent repair. Post-operatively, emergent patients had increased length of stay, major complication rates, ICU utilization, reoperation, and mortality (all p < 0.05). Emergent group recurrence rates were higher and occurred faster secondary to increased use of gastropexy alone as treatment (p > 0.05). With a formal PEH repair, there was no difference in rate or timing of recurrence. CONCLUSIONS Emergent patients are more likely to suffer complications, require ICU care, have a higher mortality, and an increased likelihood of reoperation. A graduated increase in HSV increasingly predicts the need for an emergent operation. Those patients presenting electively with a large PEH may benefit from early elective surgery.

中文翻译：

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食管旁疝紧急修复的结果和 CT 扫描三维体积分析：预测需要紧急修复的患者。

引言 在食管旁疝 (PEH) 患者中，选择性修复与观察等待仍然存在争议。生成预测因素以确定紧急修复风险最大的患者可能会有所帮助。本研究的目的是评估接受选择性与紧急 PEH 修复的患者，并通过裂孔缺损区域 (HDA) 和胸内疝囊体积 (HSV) 的 3D 体积分析来补充这种比较，以确定增加紧急修复可能性的风险因素。方法 对所有接受择期和紧急 PEH 修复的患者进行前瞻性登记、单中心疝数据库的回顾性审查。使用体积分析软件对具有充分术前计算机断层扫描 (CT) 成像的患者进行分析。结果 376 例 PEH 患者中，32 例（8. 5%）出现了。急诊患者术前胃灼热（68.8%vs85.1%，p = 0.016）和反流（21.9%vs40.2%，p = 0.04）发生率较低，其他症状发生率相似。急诊患者更常出现 IV 型 PEH（43.8% 对 13.5%，p < 0.001）。对 201 名患者进行了体积分析，急诊患者的 HSV 更大（805.6 ± 483.5vs398.0 ± 353.1cm3，p < 0.001）和 HDA（41.7 ± 19.5vs26.5 ± 14.7 cm2，p < 0.001）。在多变量分析中，HSV 增加 100cm3（OR 1.17 CI 1.02-1.35，p = 0.022）与紧急修复的可能性更大独立相关。术后，急诊患者的住院时间、主要并发症发生率、ICU使用率、再手术率和死亡率均增加（均p < 0.05）。由于增加单独使用胃固定术作为治疗，紧急组的复发率更高且发生更快（p > 0.05）。对于正式的 PEH 修复，复发率或复发时间没有差异。结论 急诊患者更容易出现并发症，需要 ICU 护理，死亡率更高，再次手术的可能性增加。HSV 的逐渐增加越来越预示着需要紧急手术。那些择期出现大 PEH 的患者可能会受益于早期择期手术。HSV 的逐渐增加越来越预示着需要紧急手术。那些择期出现大 PEH 的患者可能会受益于早期择期手术。HSV 的逐渐增加越来越预示着需要紧急手术。那些择期出现大 PEH 的患者可能会受益于早期择期手术。