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Surgical Endoscopy

, Volume 34, Issue 2, pp 686–695 | Cite as

Who gets a PEG? An analysis of simultaneous PEG placement during elective laparoscopic paraesophageal hernia repair

  • Christopher G. YheulonEmail author
  • Fadi M. Balla
  • Edward Lin
  • S. Scott DavisJr.
Article

Abstract

Introduction

Percutaneous Endoscopic Gastrostomy (PEG) is an infrequent adjunct in elective paraesophageal hernia repair (PEHR). Guidelines denote that PEG “may facilitate postoperative care in selected patients.” Though there is sparse literature defining which patients may benefit. The purpose of this study is to determine factors associated with simultaneous PEG placement during PEHR and their subsequent outcomes.

Methods

The NSQIP database was queried from 2011 to 2016 for patients undergoing elective laparoscopic PEHR. Cases were excluded if PEHR or fundoplasty was not the primary procedure, a concomitant bariatric procedure was performed, or if the primary surgeon was not a general or cardiothoracic surgeon. Groups were Propensity Score Matched for age, BMI, and ASA Class.

Results

15700 patients were identified, 371 who underwent simultaneous PEG placement (2.4%). Non-PEG patients were matched at a 5:1 ratio, producing 1855 controls. PEG patients had higher rates of pre-operative dyspnea (OR 1.45, p = 0.0110), pre-operative weight loss (OR 2.87, p = 0.0001), and lower pre-operative albumin (3.92 vs. 4.01, p = 0.0129). PEG patients had more intra-operative contamination (mean Wound Classification 1.54 vs. 1.38, p < 0.0001) and longer case durations (170 vs. 148 min, p < 0.0001). PEG patients had longer lengths of stay (3.4 vs. 2.5 days, p = 0.0001), rates of superficial SSI (OR 5.82, p = 0.0012), peri-operative transfusions (OR 2.68, p = 0.0197), and pulmonary emboli (OR 3.61, p = 0.0359).

Conclusion

Patients undergoing simultaneous PEG during PEHR are more likely to have respiratory symptoms, markers of malnutrition, and intra-operative factors indicative of more technically challenging cases. These patients have longer hospitalizations, higher rates of superficial SSI, and more pulmonary emboli.

Keywords

Percutaneous endoscopic gastrostomy PEG Paraesophageal Hiatal Hernia Laparoscopic 

Notes

Funding

The authors received no funding or other support for the creation of this manuscript to include the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI), and other(s).

Compliance with ethical standards

Disclosures

Drs. Yheulon, Balla, Lin, and Davis have no conflicts of interest or any relevant financial ties to disclose.

Supplementary material

464_2019_6815_MOESM1_ESM.docx (123 kb)
Supplementary material 1 (DOCX 122 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of General and GI SurgeryEmory University HospitalAtlantaUSA
  2. 2.Department of SurgeryKaiser Westside Medical CenterHillsboroUSA

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