218. Dyspnoea Improves Following Repair of Paraoesophageal Hernia and Is Not Necessarily a Contraindication to Surgery

Abstract

Paraoesophageal hernias (PEH) are often symptomatic and can lead to life-threatening complications such as volvulus and ischemia. Recently dyspnoea was reported as most prevalent symptom of giant hiatus herniae. The aim of this study is to evaluate the effect of surgery on resolution of dyspnoea amongst patients with giant hiatus hernia defined as greater than 30% of the stomach above the diaphragm. Data were extracted from a prospectively maintained single surgeon database containing records of patients undergoing composite hernia repair. Patients who underwent composite laparoscopic repair of giant paraoesophageal hernia between March 2009 and December 2015 and had documented dyspnoea were included. Inclusion criteria were met by 154 patients. Primary outcome of the analysis included preoperative and postoperative dyspnoea. Secondary outcomes included complications and post-operative symptoms. The mean age at time of surgery was 71.2 years (range 49–93, SD 9.66). Surgery resulted in near complete resolution of dyspnoea (2.6% postoperatively, P-value <0.001). Significant improvement was also noted in dysphagia, although not micro-aspiration. Dyspnoea resolves following laparoscopic repair of giant paraoesophageal hernia. The presence of dyspnoea should be regarded as an indication rather than a barrier to surgery. We recommend all patients with giant hiatus hernia to be assessed by a specialist surgical service.