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Meta-Analysis
. 2025 May 19;20(1):41.
doi: 10.1186/s13017-025-00617-3.

Acute paraesophageal hernia with gastric volvulus. Results of surgical treatment: a systematic review and meta-analysis

Carlos Manterola  1   2 , Enrique Biel  3   4   5 , Josue Rivadeneira  6   7 , Manuel Pera  8   9   10   11 , Luis Grande  8   10   11
Affiliations
Meta-Analysis

Acute paraesophageal hernia with gastric volvulus. Results of surgical treatment: a systematic review and meta-analysis

Carlos Manterola et al. World J Emerg Surg. .

Abstract

Introduction: Acute gastric volvulus (AGV), is an uncommon complication of large paraesophageal hernias (PEH), resulting in closed-loop obstruction that may lead to incarceration and strangulation. The aim of this study was to summarize the evidence on clinical characteristics, surgical treatment, postoperative complications (POC), recurrence, and 30-day mortality (30DM), in patients undergoing surgery for AGV secondary to PEH.

Methods: A systematic review including studies on AGV secondary to PEH was conducted. Searches were performed in WoS, Embase, Medline, Scopus, BIREME-BV and SciELO. Primary outcomes included POC, 30DM and recurrence. Secondary outcomes comprised publication date, study origin and design, number of patients, volvulus type, hospital stay length, treatments; and methodological quality (MQ) of studies assessed using MInCir-T and MInCir-Pr2 scales. Descriptive statistics, weighted averages (WA), least squares logistic regression for comparisons, and meta-analysis of POC prevalence and HM were applied.

Results: Of 1049 studies 171 met selection criteria, encompassing 15,178 patients. The WA age of patients was 75.3 ± 13.9 years, with 51.3% female. Most studies originated from USA (31.6%), with 52.6% published in the last decade. The WA of hospital stay was 7.9 ± 5.3 days. Among patients, 32.0% experienced POC, 7.6% required reinterventions and HM was 5.7%. MQ scores averaged 8.9 ± 2.3 (MInCir-T) and 13.4 ± 5.4 (MInCir-Pr2). When comparing 1990-2014 and 2015-2024 periods, there were significant differences in age, reinterventions, readmissions and recurrence rates.

Conclusions: Despite surgical and resuscitative advancements, AGV prognosis remains poor, with high POC rates, prolonged hospitalization and significant 30DM. These findings emphasize the importance of early diagnosis and timely intervention for acute PEH to improve surgical outcomes.

Keywords: Gastric volvulus; Hiatal hernia [Mesh]; Hospital Mortality [Mesh]; Postoperative Complications [Mesh]; Stomach Volvulus [Mesh]; Systematic review.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the analyzed studies
Fig. 2
Fig. 2
Meta-analyses of prevalence of POC. A) Forrest plot. POC rate was 30% (95% CI: 23-37%). B) Funnel plot. There was great heterogeneity (I2: 94%)
Fig. 3
Fig. 3
Meta-analyses of prevalences of 30-day mortality. A) Forrest plot. 30DM rate was 3% (95% CI: 2-5%). B) Funnel plot. There was great heterogeneity (I2: 93%)
See this image and copyright information in PMC

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