231 Evaluation of Short-and Long-Term Outcomes Following Hiatus Hernia Repair at West Hertfordshire Teaching Hospitals NHS Trust

Abstract Aim This audit aimed to evaluate the short-term and long-term outcomes following elective hiatus hernia repair, focusing on complication rates, surgical metrics, symptom resolution and recurrence. Method A retrospective audit was conducted on adult patients (≥18 years) who underwent robotic-assisted, laparoscopic, or open hiatus hernia repair at West Hertfordshire Hospitals between April 2022 and April 2025. Data collected included demographics, operative details, complication rates, symptom recurrence, and follow-up information. Results Ninety-two patients underwent hiatus hernia repair, with a median age of 68.5 years and a median BMI of 28.06. Reflux MDT review was undertaken in 80.4% (74) of cases. Most procedures were primary (95.7%), with Toupet (n=29), Nissen (n=26), and Dor (n=29) fundoplications being the most commonly performed. The median operative time was 214 minutes, and length of hospital stay (LoS) was 3 days. Short-term complications were low: gastric perforation in 1.1%, bleeding or hematoma in 5.4%, pulmonary embolism in and 1.1%. There were no cases of oesophageal perforation, vagal nerve injury, or pneumothorax. Long-term complications included dysphagia (7.6%), gas bloat syndrome (7.6%), hernia recurrence (3.3%), reflux recurrence (12%), and 30-day readmission (3.3%). No mortality was reported. Postoperative discontinuation of PPIs occurred in 56.9% of patients. Conclusions Hiatus hernia repair demonstrated favorable outcomes with low morbidity, recurrence and readmission rates; with most patients experiencing symptom relief. Although the median LoS exceeded the national average, we aim to implement robust perioperative protocol that includes consistent MDT involvement, expanding the use of robotic-assisted surgery, as well as introducing virtual hospital for early discharge and follow up.