228 Long-Term Outcome Following Surgical Management of Type III/IV Giant Paraoesophageal Hernias

Abstract Aim Surgery that is complex and challenging is recommended for giant paraoesophageal hernia (GPEH) patients, as complications (volvulus, obstruction and strangulation of the stomach) can lead to high morbidity and even mortality (up to 30%). The study reviewed long-term outcomes for patients who underwent hiatal reconstruction with a biologic prosthesis. Method Retrospective analysis of prospective data of 163 consecutive GPEH patients who underwent a standardised procedure between March 2008-December 2024 in a large DGH. The data collected were social demographics, operative details, and validated gastro-oesophageal reflux disease – health-related quality of life (GERD-HRQL) questionnaire at preoperative, 6-month postoperative and long-term follow-up. Results 163 included M:F, age, BMI and ASA 49 (30%):114 (70%), 69 (41-89), 29 (18-44) and II (I-III) respectively. Eighty-nine (55%), 40 (25%) and 34 (20%) had 50%, 75% and 100% intrathoracic stomach, respectively. One conversion, 2 (return to theatre), 6 (3.68%) 30-day mortality and 41 unrelated deaths. Preoperative and postoperative {PO (6-month)} GERD-HRQL scores for 157 were 21.98 ±7.4 and 1.45±4.3 respectively. Of 116, 102(88%) were contactable: GERD-HRQL scores 1-5 years, 6-10 years and >10 years PO were 2.5±1.4, 3.45±2.4 and 3.67±3.7 respectively. 140(89%) of 157 were satisfied 6 months PO. Of 102, 28(85%) of 33 1-5 years PO, 27 (87%) of 31 6-10 years PO and 41 (93%) of 44 >10 years PO were satisfied. Conclusions The study showed excellent long-term outcomes and patient satisfaction and recommends that surgery be offered to the medically fit patients as GPEH progresses and deteriorates over time.