{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:37:03Z","timestamp":1792510623875,"version":"4.5.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000770","name":"University of Manchester","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000770","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Patients with a giant hiatus hernia may present with acute symptoms caused by obstruction, strangulation, perforation and uncontrolled bleeding. Emergency surgical repair has been associated with significant mortality and even greater morbidity. The aim of this study is to investigate the short-term outcomes following emergency repair of giant hiatus hernias.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Data were retrospectively collected for all patients who underwent emergency surgical repair of giant hiatus hernia in a university teaching hospital between 2009 and 2019. Outcomes were short-term morbidity and mortality. We also assessed the association of clinical predictor covariates, including age, ASA class and time to surgery, with risk for major morbidity.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Thirty-seven patients with a median age of 68 years were identified. Following surgery, 9 patients (24.3%) developed organ dysfunction that required admission to the intensive care unit. Two patients (5.4%) underwent revision surgery and 3 (8.1%) developed pneumothorax that necessitated chest drain insertion. The commonest complication was pneumonia, which occurred in 13 patients (35.1%). Two deaths (5.4%) occurred within 30 days from surgery.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Emergency repair of giant hiatus hernia is associated with high rates of major morbidity, which includes poor functional status, further interventions, repeat surgery, and admission to the intensive care unit. Larger studies are warranted for long-term follow-up to assess post-operative quality of life is needed for asymptomatic patients and for those undergoing emergency surgery.<\/jats:p>","DOI":"10.3389\/fsurg.2021.628477","type":"journal-article","created":{"date-parts":[[2021,2,13]],"date-time":"2021-02-13T14:38:32Z","timestamp":1613227112000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Do Poor Functional Outcomes and Higher Morbidity Following Emergency Repair of Giant Hiatus Hernia Warrant Elective Surgery in Asymptomatic Patients?"],"prefix":"10.3389","volume":"8","author":[{"given":"Iulia","family":"Bujoreanu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniya","family":"Abrar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savvas","family":"Lampridis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravindra","family":"Date","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"267","DOI":"10.5009\/gnl.2011.5.3.267","article-title":"Clinical significance of hiatal hernia","volume":"5","author":"Hyun","year":"2011","journal-title":"Gut Liver"},{"key":"B2","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1007\/s00464-001-8194-7","article-title":"Long-term outcome of laparoscopic repair of paraesophageal hernia","volume":"16","author":"Mattar","year":"2002","journal-title":"Surg Endosc."},{"key":"B3","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.jtcvs.2009.10.005","article-title":"Outcomes after a decade of laparoscopic giant paraesophageal hernia repair","volume":"139","author":"Luketich","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"4409","DOI":"10.1007\/s00464-013-3173-3","article-title":"Guidelines for the management of hiatal hernia","volume":"27","author":"Kohn","year":"2013","journal-title":"Surg Endosc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s13017-020-00316-1","article-title":"Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review","volume":"15","author":"Ceccarelli","year":"2020","journal-title":"World J Emerg Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/j.bpg.2007.12.007","article-title":"Approaches to the diagnosis and grading of hiatal hernia","volume":"22","author":"Kahrilas","year":"2008","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.jtcvs.2008.05.042","article-title":"Fatal complications of adult paraesophageal hernia: a population-based study","volume":"137","author":"Sihvo","year":"2009","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1001\/jamasurg.2015.1867","article-title":"Morbidity and mortality associated with elective or emergency paraesophageal hernia repair","volume":"150","author":"Kaplan","year":"2015","journal-title":"JAMA Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"3473","DOI":"10.1007\/s00464-014-3626-3","article-title":"A population-based analysis of emergent versus elective paraesophageal hernia repair using the Nationwide Inpatient Sample","volume":"28","author":"Jassim","year":"2014","journal-title":"Surg Endosc"},{"key":"B10","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/S0895-4356(02)00585-1","article-title":"How to measure comorbidity. a critical review of available methods","volume":"56","author":"de Groot","year":"2003","journal-title":"J Clin Epidemiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries","volume":"173","author":"Quan","year":"2011","journal-title":"Am J Epidemiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/0895-4356(92)90133-8","article-title":"Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases","volume":"45","author":"Deyo","year":"1992","journal-title":"J Clin Epidemiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1754-9493-8-31","article-title":"Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients","volume":"8","author":"Mentula","year":"2014","journal-title":"Patient Saf Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The clavien-dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1007\/s00464-015-4447-8","article-title":"Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?","volume":"30","author":"Klinginsmith","year":"2016","journal-title":"Surg Endosc"},{"key":"B16","doi-asserted-by":"publisher","first-page":"A478.2","DOI":"10.1136\/gutjnl-2015-309861.1048","article-title":"PTH-160 Laparoscopic repair of giant hiatus hernia significantly improves quality of life \u2013 a single centre experience","volume":"64","author":"Goh","year":"2015","journal-title":"Gut."},{"key":"B17","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s11605-016-3231-y","article-title":"Non-elective paraesophageal hernia repair portends worse outcomes in comparable patients: a propensity-adjusted analysis","volume":"21","year":"2017","journal-title":"J Gastrointest Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s11605-009-1106-1","article-title":"Should elective repair of intrathoracic stomach be encouraged?","volume":"14","author":"Polomsky","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1007\/s11605-017-3495-x","article-title":"Acute Vs. elective paraesophageal hernia repair: endoscopic gastric decompression allows semi-elective surgery in a majority of acute patients","volume":"22","author":"Wirsching","year":"2018","journal-title":"J Gastrointest Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.jtcvs.2012.12.026","article-title":"A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair","volume":"145","author":"Ballian","year":"2013","journal-title":"J Thoracic Cardiovasc Surg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1097\/SLA.0000000000001877","article-title":"Practice patterns and outcomes after hospital admission with acute para-esophageal hernia in England","volume":"264","author":"Markar","year":"2016","journal-title":"Ann Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1007\/s00464-018-6463-y","article-title":"Long-term outcomes following surgical repair of giant paraoesophageal hiatus hernia","volume":"33","author":"Quinn","year":"2019","journal-title":"Surg Endosc"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e2019","DOI":"10.4293\/JSLS.2019.00015","article-title":"Emergent repair of paraesophageal hernias and the argument for elective repair","volume":"23","author":"Shea","year":"2019","journal-title":"J Soc Laparoendosc Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1007\/s00464-019-06764-4","article-title":"Modern era surgical outcomes of elective and emergency giant paraesophageal hernia repair at a high-volume referral center","volume":"34","author":"Sorial","year":"2019","journal-title":"Surg Endosc."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1007\/s00464-015-4425-1","article-title":"The threatened stomach: management of the acute gastric volvulus","volume":"30","author":"Light","year":"2016","journal-title":"Surg Endosc."},{"key":"B26","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1089\/lap.2012.0199","article-title":"Surgical management of emergency and elective giant paraesophageal hiatus hernias","volume":"23","author":"Shaikh","year":"2013","journal-title":"J Laparoendosc Adv Surg Tech"},{"key":"B27","first-page":"394","article-title":"Surgical treatment of para-oesophageal hiatal hernia","volume":"83","author":"Rogers","year":"2001","journal-title":"Ann R Coll Surg Engl"},{"key":"B28","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1067\/msy.2000.108425","article-title":"A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair","volume":"128","author":"Geha","year":"2000","journal-title":"Surgery"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.628477\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,13]],"date-time":"2021-02-13T14:38:35Z","timestamp":1613227115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.628477\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,11]]},"references-count":28,"alternative-id":["10.3389\/fsurg.2021.628477"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2021.628477","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,11]]},"article-number":"628477"}}