OGBN P31 Laparoscopic versus open repair of giant paraoesophageal herniae: a 4-year retrospective study

Abstract

Abstract Background Although laparoscopic repair of giant paraoesophageal hernia (PEH) has known advantages over open repair including a reduced post-operative length of stay (LOS) and reduced post-operative pain, there has been concern amongst surgeons regarding the recurrence rate. We sought to further analyse differences in outcomes in a retrospective series of patients with giant hiatus hernia in a single tertiary centre. Methods All giant PEH receiving operative repair at a tertiary referral centre (UCLH) were reviewed retrospectively over a one-year period from July 2019-July 2022. Diagnosis was made on gastroscopy and computer tomography (CT). A giant PEH was defined as one in which the hernia contained at least 50% of the stomach. If the patient was symptomatic post-operatively they were investigated for recurrence with gastroscopy and CT. Results The laparoscopic cohort (n=14, median age of 72 years, ASA 2) had similar demographics to those receiving open repair (n=21, median age of 68 years, ASA 2.5). Median length of stay was shorter in the laparoscopic cohort compared to the open cohort (3.5 days (1-7) versus 7 days (5-9)). The laparoscopic and open cohorts had similar rates of minor complications (42.8% (6=2, Clavien Dindo 2) versus 47.6% (n=10, Clavien Dindo 2))respectively. Recurrence of reflux or dysphagia symptoms was higher in those who had a laparoscopic repair (28.6% versus 14.3%). One radiologically confirmed recurrence occurred in the open group (4.7%). Conclusions Although the benefits of a faster post-operative recovery with a shorter LOS were clear in the cohort following laparoscopic repair, a higher rate of recurrence of symptoms was evident within those receiving a laparoscopic repair. Large, controlled, prospective studies with long-term follow-up are required in order to further establish differences in outcomes between laparoscopic and open repair of giant PEH.