160: PATIENT-TAILORED ALGORITHM FOR POSTERIOR CRUROPLASTY: TECHNIQUE DESCRIPTION AND COMPARISON WITH HIATAL SURFACE AREA

Abstract

Abstract Background and aim Different surgical techniques have been described for laparoscopic crural approximation, ranging from simple suture to mesh reinforced repair. Nowadays, the choice of the most appropriate surgical strategy is left to surgeon experience and lacks of standardization. Our objective is to describe a patient-tailored decisional algorithm based on intraoperative findings and measurements (Table 1). In addition, we aimed to compare this technique with the previously described Hiatal Surface Area (HSA) method. Methods Prospective single-center cohort study (November 2015–June 2021). Perioperative outcomes, timing of recurrence, and quality of life were analysed. Results Overall, 104 patients were included. Overall, 78 (75.0%) patients underwent simple suture repair (= < 5points) while crural mesh [Phasix ST®-Bard] repair as used in 26 (25.0%) patients (Figure 1). Our patient-tailored algorithm was compared to HSA method in 30 patients, with 93.3% of concordance. Toupet fundoplication was fashioned in all patients. No intraoperative complications occurred. The median postoperative stay was 1.8 days (range 1–7). The overall postoperative complication rate was 3.8%. The median follow-up was 29 months (range 1–58) with 95 patients having a minimum follow-up of 6 months. No mesh-related complication occurred. Recurrent hernia was diagnosed in three patients (2.9%) all managed with PPI. Compared to baseline, the median GERD-HRQL (P = 0.003) was significantly improved. Conclusion The application of a ‘patient-tailored’ decisional algorithm is safe and seems effective in the medium-term follow-up. The use of this algorithm may improve procedure reproducibility and standardization. The comparison with the HSA showed a high concordance, even though our algorithm is simpler and more manageable. Table https://secure.sem-2000.it/semUpload/OLC/file/9203828791100911681076702/94476_Table.jpg.