ArticleSurgical endoscopy2026
Timing matters: a comparative analysis of semi-elective, elective, and emergent laparoscopic paraesophageal hernia repair.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPatients with paraesophageal hernias (PEH) who present with obstruction or other acute symptoms are generally treated with one of three approaches: emergent repair, discharge after stabilization with subsequent elective repair, or "semi-elective repair," defined as elective repair performed during the same hospitalization for acute symptoms but at least one day post-admission. Outcomes associated with semi-elective repair are not well established in the literature. To help address this gap, we evaluated 30-day postoperative outcomes following semi-elective laparoscopic PEH repair and compared them with outcomes following elective and emergent PEH repair.
methodsWe queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients undergoing elective, semi-elective, and emergent laparoscopic PEH repair from 2011 to 2020. Procedures resulting in conversion to open surgery or those requiring resection were excluded. We evaluated 30-day postoperative outcomes using multivariable linear and logistic regression, as well as propensity score matched analyses.
resultsA total of 34,617 patients underwent elective laparoscopic PEH repair, 2,304 underwent semi-elective PEH repair, and 809 underwent emergent PEH repair. Compared to elective repair, semi-elective PEH repair was independently associated with significantly higher rates of transfusion, deep venous thrombosis/thrombophlebitis, pneumonia/pulmonary embolism, surgical site infection, sepsis/septic shock, readmission, increased length of stay, and increased operative time (all p < 0.001). When compared to emergent repair, semi-elective repair was independently associated with a decreased rate of sepsis/septic shock (p = 0.003).
conclusionsSemi-elective laparoscopic PEH repair is associated with higher postoperative morbidity compared with elective repair, but improved outcomes compared to emergent repair. While semi-elective repair following inpatient stabilization may still be necessary for some patients with acute PEH symptoms, temporizing measures with a planned staged repair should be considered whenever feasible.
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