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INTRODUCTION: Hiatal hernia commonly occurs in adults. Although most patients are asymptomatic, some experience reflux symptoms or dysphagia. These patients are frequently managed with acid suppression and lifestyle changes. However, medical management does not provide durable relief for some patients; therefore, surgical repair is considered. Routine preoperative investigations include esophagoscopy, esophagography, and manometry. We investigated the role of preoperative motility studies for the management of these patients when partial fundoplication is planned. METHODS: We performed a retrospective review of 185 patients who underwent elective minimally invasive hiatal hernia repair with partial fundoplication between 2014 and 2018. Patients were divided into two groups based on whether a preoperative motility study was performed. The primary outcomes were postoperative dysphagia, complications, postoperative interventions, and use of proton pump inhibitors. RESULTS: Ninety-nine patients underwent preoperative manometry and 86 did not. The lack of preoperative manometry was not associated with increased postoperative morbidity, including leak rate, readmission, and 30-d mortality. The postoperative dysphagia rates of the manometry and nonmanometry groups were 5% (5/99 patients) and 7% (6/86 patients) (P = 0.80), respectively. Furthermore, seven of 99 (7%) patients in the manometry group and 10 of 86 (12%) (P = 0.42) patients in the nonmanometry group underwent interventions, mainly endoscopic dilation, postoperatively owing to symptom recurrence. CONCLUSIONS: Forgoing preoperative manometry was not associated with significant adverse outcomes after minimally invasive hiatal hernia repair. Although manometry is reasonable to perform, it should not be considered a mandatory part of the preoperative assessment when partial fundoplication is planned.
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INTRODUCTION: Due to the high morbidity associated with esophagectomies, patients are often directly admitted to intensive care units (ICUs) for postoperative monitoring. However, critical complications can arise after this initial ICU stay. We hypothesized that the timing of ICU stay was not optimal for the care of patients after esophagectomy and aimed to determine when patients are at risk for developing critical complications. METHODS: We searched the National Safety and Quality Improvement Program for patients who underwent an esophagectomy between 2016 and 2021. The outcome of interest was the interval between surgery and first critical complication. A critical complication was defined as one likely to require intensive care, including respiratory failure, septic shock, etc. Multivariate regression was performed to identify the risks of complications. RESULTS: This study included 6813 patients from more than 70 institutions. Within the first 30 d postesophagectomy, 21.59% of patients experienced at least one critical complication. Half of first critical complications occurred after postoperative day 5, and 85.05% of them occurred after postoperative day 2. Risk factors for critical complications included age greater than 60 y, preoperative comorbidities, and open surgical approach. Malignancies were associated with a significantly lower incidence of critical complications. CONCLUSIONS: Critical complications occurred beyond the immediate postesophagectomy period. Therefore, low-risk patients undergoing minimally invasive esophagectomies can be safely monitored outside the ICU, allowing for better patient care and resource utilization.