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

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ID: 325762
2026
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Ranked #33 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Esophageal Surgery Background 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. Methods 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. Results 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. Conclusion 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.
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Authors Keouna Pather, Timothy Shane Hester, Jana Sacco, Ziad Awad, Ruchir Puri
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.092
URL
https://doi.org/10.1093/dote/doag077.092
Keywords Keywords not found

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