Sac Excision at the Time of Surgery Can Predict Hernia Recurrences and a Need for Reoperation in Patients

BACKGROUND: Paraesophageal hernias are a prevalent medical condition often treated with surgical intervention, and decisions regarding hernia sac management are involved. Sac excision during PEH repair has emerged as a viable and safe management strategy, with potential implications for patient outcomes. This study aimed to assess the impact of sac excision on hernia recurrence, reoperation rates, and postoperative gastroesophageal reflux disease (GERD) in patients undergoing hernia repair. METHODS: A retrospective analysis was conducted on patients who underwent paraesophageal hernia repair between 2014 and 2022. Data on patient demographics, preoperative evaluation, surgical technique, and long-term follow-up were collected and analyzed. Primary outcomes included hernia recurrence, reoperation rates, and postoperative GERD assessed over a mean follow-up of 1.8 years. RESULTS: Analysis of a 1154-patient cohort revealed that sac excision during paraesophageal hernia repair did not significantly affect hernia recurrence (P=0.27). Notably, the reoperation rate was similar between patients with and without sac excision (P=0.28), indicating no significant difference in the need for reoperation. However, sac excision was associated with a lower incidence of persistent postoperative gastroesophageal reflux disease (GERD) (P=0.03). CONCLUSIONS: Sac excision during paraesophageal hernia repair does not significantly impact hernia recurrence or reoperation rates but may be associated with a lower incidence of persistent postoperative GERD.