280. MANOMETRIC FINDINGS IN PATIENTS WITH GIANT HIATAL HERNIA: OESOPHAGEAL PHYSIOLOGY APPEARS TO IMPROVE WITH SURGERY

Abstract Background High resolution manometry (HRM) is a gold standard test of oesophageal physiology. The use of HRM in patients with giant hiatus hernia (GHH) is limited by historical technical challenges as well as unclear clinical implications of the findings. The aim of this study is to demonstrate feasibility of HRM in patients with GHH and study effect of surgery on oesophageal physiology of patients undergoing GHH repair. Methods Data was extracted from a prospectively populated database of patients with giant (>30% stomach above diaphragm) hiatus hernias. All patients that underwent HRM before and after surgery were included. Manometric findings before and after surgery were analysed and compared. Patient symptoms were correlated with manometric findings. Results Inclusion criteria were met by 30 patients: 83% female, average age 74 (range 51-86), 93% had type III hernia containing on average 55% of stomach. All operations but one were performed laparoscopically. Pre-operatively average LOS length was 1.89cm which improved significantly to 2.19cm after surgery (p<0.05). Nine patients had ineffective oesophageal motility on index study which normalised post operatively in 4 patients. Lower oesophageal sphincter integrated relaxation pressure (IRP) increased post-operatively from 9.07mmHg to 11.52mmHg (p<0.05). Distal contractility improved post-operatively, however this was not significant. Most common presenting symptoms were dyspnoea, anaemia, retrosternal pain, and dysphagia. There was no association between dysphagia and manometric findings before or after surgery. Conclusion This study provides an insight into HRM findings in patients with GHH before and after surgery. Majority of the physiological parameters improved with surgery. There was no correlation of symptom of dysphagia with manometric findings.