OGBN P24 Primary symptom indication can be a predictor of outcomes in revisional anti-reflux surgery

Abstract

Abstract Background Symptom recurrence after primary hiatus hernia surgery is an established problem and revision anti-reflux surgery may be indicated in select cases of recurrence after primary surgery. Previous studies on this subject are of small number and often lack objective measures. Our aim is to assess the relationship between primary symptom indication and a variety of objective and subjective post operative outcomes. Methods A prospectively maintained single surgeon database of revisional hiatus hernia surgery from 1992 to 2022 was retrospectively evaluated. This was a consecutive cohort of adults greater than 18 years of age. The symptomatic, anatomical, and physiological indications for surgery were reviewed. The symptoms described by patients were grouped into four categories: typical reflux, volume, obstructive and gastric motility symptoms. The intraoperative findings and post operative outcomes were analysed. The dataset consisted of 379 patients, of whom 59% were female. The average age of this cohort at the time of primary revisional surgery was 59 years (range 19-91). Results Intraoperative findings of the revision operations found that 32% had a large hiatus hernia, 30% had a small hernia, 16% had a moderate hernia, 8% had a very large hernia. Patients who initially presented with volume symptoms appeared more likely to have two or more revision operations than patients who presented with no volume symptoms. Symptom score improvement was seen in reflux and dysphagia symptoms following revisional surgery. No significant improvement was seen in volume symptoms. Symptom focused questions in the GIQLI score demonstrated a statistically significant improvement in dysphagia symptoms 12 months post surgery (p=0.021). Conclusions Patients presenting initially with volume symptoms may be more likely to require multiple revision operations. This could be either due to an undiagnosed underlying motility disorder or advanced severity at presentation. Consideration of an alternative procedure such as roux-en-y gastric bypass could be entertained in this group.