P-BN15 Outcomes following surgical repair of giant para-oesophageal hernia of over 200 cases with long-term follow up: a 20-year experience

Abstract

Abstract Background Symptomatic giant para-oesophageal hernia (PEH) can often be troublesome and may require surgical intervention. It commonly presents with dyspnoea, post-prandial pain, vomiting and dysphagia but rarely strangulation. In a good proportion of patients, iron deficiency anaemia may also be present. Patients are often elderly and may have co-morbidities and hence there may be a reluctance to refer and to offer surgery. This long-term study offers an insight to the outcomes following this complex surgery in a relatively elderly cohort of patients. Methods A retrospective analysis of prospectively collected data of patients who underwent surgery for symptomatic PEH from January 2001- June 2021 was performed. Clinical presentation, management, post-operative clinical outcomes, radiographic evaluation, pre and post-operative haemoglobin levels, respiratory function {Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1)} as well as quality-of-life (QoL) with SF-36 questioners (including general health, physical, emotional and social components) were assessed. Results 202 patients (122-females) with median age 68 years (36-88) underwent PEH-surgery. The commonest symptomEighty-one presented with dyspnoea(41%). Ninety-five(47%) were ASA III, 119(59%) had microcytic-anaemia. 142(70%) had a fundoplication during PEHR. Hospital-stay was significantly lower in laparoscopic group Mortality:1.8%(2/112). Median follow-up:10 years. Symptoms improved in 166(82%) with respiratory function and anaemia. 42(21%) had radiological recurrences but only nine (4.5%) clinical recurrence requiring surgery. Conclusions Laparoscopic repair of giant para-oesophageal hernia is safe with good outcomes in all age groups with improvement in symptoms, quality of life, respiratory function and associated anaemia.