BN SO32 - Operative techniques and outcomes following giant hiatus hernia repair: 5 years of tertiary centre experience

Abstract Background Giant hiatus hernia (GHH) repair is a complex surgical challenge, often requiring advanced techniques and specialised expertise. Whilst the repair of small hiatus hernias is well-documented, the optimal strategy for giant hernias remains debated. This study reviews five years of experience at a tertiary centre, focusing on operative techniques and outcomes. The aim is to identify trends and best practices that enhance patient outcomes and minimise complications in the repair of GHH. Method All patients undergoing primary GHH surgery between March 2019 and March 2024 at a tertiary institution and a five surgeon upper GI service. Retrospective review of electronic records were utilised to document patient demographics, type of hernia, operative details including surgical approach (open/laparoscopic/robotic), use of fundoplication, use of mesh and gastropexy. Outcomes measured included 30-day morbidity (Clavien-Dindo (CD) grading), 30-day mortality, binary symptom recurrence, length of stay (LOS), need for return to theatre (RTT) and RTT versus mesh use. Analysis undertaken using paired t-test. Statistical significance was set as p<0.05. Results 91 patients underwent GHH repair with median age 70 (31-93) years, 66.7% female, average BMI 30.8(±5.4). ASA: ≤2 (72.4%), 3 (25.5%), 4 (2.1%). Hernia types: 2 (15.7%), 3 (55.4%), 4 (28.9%). Approach: open 6.6%, laparoscopic 61.5%, robotic 31.9%. Fundoplication in 88%, gastropexy in 13%, 2 cases utilised both. Mesh: 91.2% without, 8.8% biologic, nil prosthetic. Median LOS 2 days (0-161). Median follow-up 8 weeks (1-172). Symptoms recurred in 25.6%. 94.5% had no significant complications (CD≤2). 5.5% had RTT≤30 days. 4.4% RTT>30 days. No mortalities. No significant difference in RTT and mesh use (p=0.7832). Conclusion This five-year review confirms that GHH repair using open, laparoscopic, and robotic techniques is effective and safe, even in an older population with high ASA scores. The study highlights minimal complications (94.5% with CD≤2). Only 4.8% required a RTT within 30 days. RTT was not significantly impacted by the use of mesh however this may represent a type two error given the limited use of mesh and low number of patients that RTT. These findings support the tailored use of advanced surgical techniques, mesh, and gastropexy as effective strategies for managing GHH in a tertiary care setting.