Background: Paraesophageal hiatal hernia operations are complex and the most appropriate operative approach (lap vs. open) remains controversial. The aim of this study was to compare the utilization and outcome of laparoscopic versus open paraesophageal hiatal hernia repair performed at academic medical centers.
Methods: Using ICD-9 diagnosis and procedural codes, data was obtained from the University HealthSystem Consortium clinical database of 1,824 patients who underwent laparoscopic or open paraesophageal hiatal hernia repair between 2004 and 2007. The data were reviewed for demographics, length of hospital stay, 30-day readmission, morbidity, observed-to-expected (risk-adjusted) mortality, and costs.
Results: A total of 1,281 patients underwent laparoscopic repair and 543 patients underwent open repair. Patient who underwent laparoscopic repair had a significantly shorter length of stay (3.1 vs. 7.3 days, p<0.001); lower 30-day readmission rate (1.8% vs. 4.3%, p<0.01); lower overall complications (16.1% vs. 31.1%, p<0.001); lower rates of wound infections and hemorrhagic complications, and lower costs (,459 vs. ,392, p<0.001). Observed-to-expected mortality ratio was 1.2 for the laparoscopic group and 0.8 for the open group, with no difference in the observed in-hospital mortality (0.6% vs. 0.6%).
Conclusion: Within the context of this analysis of academic centers, the current practice of paraesophageal hiatal hernia repair is primarily the laparoscopic approach. Laparoscopic paraesophageal hiatal hernia repair is as safe as open repair but was associated with a significantly shorter length of stay, lower morbidity, and cost.