Objective: To assess the feasibility, outcomes, and odds of same-day surgery (SDS) in the laparoscopic elective primary repair of intrathoracic stomach (ITS). To assess the significance of percentage of intraoperative gastric incarceration in planning SDS.
Methods: ITS was defined as 100% gastric herniation into the chest on preoperative imaging. The percentage of intraoperative gastric incarceration into the chest was assessed, and patients with partial gastric incarceration were compared to those with 100% incarceration. Planning for SDS started in 2019.
Results: From 2012 to 2024, there were 1057 hiatal hernia repairs and 190/1057 (18%) primary laparoscopic ITS repairs, 8 procedures in whom percentage of intraoperative gastric incarceration was not documented were excluded, and 182 procedures were included, 127/182 (69.8%) were elective: 58/127 (45.7%) had intraoperative partial gastric incarceration and 69/127 (54.3%) had 100% incarceration. Since planning for SDS started, there were 56 elective repairs. SDS was planned in 36/56 (64.3%) and was performed in 33/36 (91.7%).Comparing 33/56 (58.9%) procedures performed as SDS to 23/56 (41.1%) not performed as SDS showed comparable sex/age/BMI/ASA. The operative time, 117 min (IQR, 100-144) vs 129 min (IQR, 110-167), p=0.134, emergency department visits: 5/33 (15.2%) vs 3/23 (13.0%), p=1.00 and readmissions: 4/33 (12.1%) vs 1/23 (4.3%), p=0.64. The odds of SDS were comparable for sex, age, BMI, percentage of intraoperative gastric incarceration, and operative time.
Conclusion: The percentage of gastric herniation on preoperative imaging does not correlate with the percentage of intraoperative gastric incarceration in about half of patients with ITS. SDS is feasible in the majority of laparoscopic elective ITS repairs and can be performed with good outcomes in patients with intraoperative partial or 100% gastric incarceration.
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