Jonas S Jensen, MD1, Jan Krzak, MD2, Henning Kold Antonsen, MD2. 1Department of Surgery, Kolding Hospital, Denmark, 2Department of Surgery, Herning Hospital, Denmark
Introduction: All symptomatic giant hiatal hernias, defined as any hiatal hernia where more than 30% of the stomach is placed intrathoracically, should be addressed with elective surgery, significantly reducing the risk of complications. Symptoms of incarceration require immediate emergency surgery and occur in less than 2% per year.
The purpose of this study was to evaluate perioperative data, outcome and patient satisfaction in patients undergoing emergency or planned surgery for giant hiatal hernia in a Danish centre.
Methods and Procedures: This retrospective study was performed using patient records of all patients undergoing emergency (E) or planned (P) primary laparoscopic repair for giant hiatal hernia at a single center over a six-year period. Demographics and characteristics of hiatal hernia and surgery were registered. Admission length, complications and readmission within 30 days were registered. All patients were subject of GERD-HRQL follow-up six months postoperatively, assessing patient satisfaction, dysphagia, reflux and reoperation.
Continuous and categorical variables were compared using student’s t-test and Chi2-test. Spearman’s correlation was calculated and reported if >0.3 and p<0.05.
Results: The study included 92 patients (E:11 & P:81). There was no differences in age, sex, BMI, size of the hiatal defect, the use of mesh-reinforced crural closure or gastropexy, or complications and readmission within 30 days, when comparing planned and emergency surgery.
There was a statistically significant difference in type of hiatal hernia (E:72.7% Type 3 & 27.3% Type 4 VS P:100% Type 3, p<0.01), fraction of stomach placed intrathoracically (E:83.3% VS P:63.3%, p<0.01), duration of surgery (E:168 min VS P:212 min, p<0.01) and admission time (E:2.3 days VS P:3.7 days, p=0.01). At follow-up there was no difference in occurrence of reflux, reoperation or patient satisfaction. There was however a significant difference in postoperative dysphagia (E: 27.3% VS P:7.4%, p=0.04).
The size of the hiatal defect and operating time both had a positive correlation with the fraction of stomach displaced intrathoracically. Emergency surgery had a positive correlation with admission time and postoperative dysphagia (rs= 0.31, p=0.01 & rs=0.31, p=0.04). Reoperation had a positive correlation with rehospitalisation (rs= 0.33, p=0.01) and a negative correlation with the use of gastropexy during primary surgery (rs= -0.34, p=0.01).
Conclusion: Planned as well as emergent laparoscopic repair of giant hiatal hernia is feasible, safe and effective with no mortality and no considerable morbidity and patient satisfaction is high six months postoperatively. Further follow-up is required to assess development of long-term adverse effects of surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78929
Program Number: P391
Presentation Session: Poster (Non CME)
Presentation Type: Poster