Minimally Invasive Surgery Should Be the Standard of Care for Paraesophageal Hernia Repair Francisco Schlottmann 1,2 & Paula D. Strassle 1,3 & Timothy M. Farrell 1,2 & Marco G. Patti 1,2 Received: 14 November 2016 /Accepted: 19 December 2016 # 2017 The Society for Surgery of the Alimentary Tract Abstract Background It is unclear if minimally invasive surgery (MIS) has been universally embraced for paraesophageal hernia (PEH) repair. The aims of this study were: (a) to assess the national utilization of MIS for PEH repair and (b) to compare the perioperative outcomes between MIS and open procedures Methods A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000– 2013. Adult patients (≥18 years old) who underwent PEH repair were included. Linear and logistic regression, adjusted for patient and hospital characteristics, were used to assess the effect of minimally invasive surgery on patient outcomes Results A total of 63,812 patients were included. An abdominal approach was used in 60,087 (94.2%) patients and a thoracic approach in 3725 (5.8%) cases. Between 2000 and 2013, the rate of MIS significantly increased in abdominal and thoracic procedures. Patients undergoing MIS were less likely to experience postoperative infection, bleeding, cardiac failure, renal failure, respiratory failure, shock, and had a lower inpatient mortality. In addition, MIS significantly reduced the length of hospital stay and the overall cost. Conclusions MIS is associated with significantly better perioperative outcomes and lower costs. These data strongly support the MIS approach as standard of care for PEH repair. Keywords Minimally invasive surgery . Paraesophageal hernia . Paraesophageal hernia repair Introduction Hiatal hernias are common finding in the general population, and given the progressive aging of the US population these numbers are expected to increase in the future. 1 Paraesophageal hernias (PEH) account for 5% of all hiatal hernias, 2 and they are associated with potentially lethal com- plications such as volvulus, strangulation, incarceration, and perforation. 3 The optimal surgical approach for PEH repair is still under debate. Traditionally, repair required either a laparotomy or thoracotomy, which was accompanied by the morbidity asso- ciated with these approaches. Since its introduction in 1992, laparoscopic PEH repair (LPEHR) has emerged as a promis- ing surgical approach for the surgical treatment of this disease. 4 In fact, laparoscopic repair has been shown to be superior to other approaches in terms of improved * Francisco Schlottmann fschlottmann@hotmail.com 1 Department of Surgery, University of North Carolina, Chapel Hill, NC, USA 2 Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA 3 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA J Gastrointest Surg DOI 10.1007/s11605-016-3345-2