P141 USE OF POLYPROPYLENE STRIPS FOR REINFORCEMENT OF THE CRUROPLASTY IN LAPAROSCOPIC PARAESOPHAGEAL HERNIA REPAIR: A RETROSPECTIVE COHORT STUDY

Aim Laparoscopic paraesophageal hernia repair is an effective treatment for symptomatic paraesophageal hernias. To reduce recurrence rates, the use of prosthetics for the crural repair has been suggested. Mesh-related complications are rare, but known to be disastrous. To address another form of crural repair, polypropylene strips are suggested. This study aimed to assess peri- and postoperative complications of reinforcement of the cruroplasty with polypropylene strips. Material and Methods From 2013 to 2020, patients with a type II, III or IV primary or recurrent paraesophageal hernia that underwent cruroplasty with polypropylene strips were retrospectively reviewed. Intra- and postoperative complications were graded according to the Clavien-Dindo classification. The incidence of symptomatic recurrent hiatal hernia (CT or endoscopy proven) and hospital stay were assessed. Results One-hundred-and-fifty-eight patients were included. Mean age was 65 years (standard deviation 10.4), 119 patients were female (75.3%). Almost 50% of surgeries took place between 2018 and 2020. Median follow-up was 7 months (interquartile range 17.5). Mean operation time in the primary hernia group was 159 minutes (standard deviation 39.0), and length of stay was 4.4 days. In 3/158 patients (2.0%) intra-operative complications occurred. Two patients developed a grade IV and seven patients a grade III postoperative complication. No mortality was recorded. Twelve recurrences (8.2%) were detected in the primary hernia group, and one (9.1%) in the recurrent hernia group. Conclusions There were no mesh-related complications seen and symptomatic recurrence rate was low, but longer follow up is needed.

755 LAPAROSCOPIC REPAIR OF GIANT PARAESOPHAGEAL HERNIAS: A SINGLE CENTER EXPERIENCE AND LITERATURE REVIEW

Paraesophageal hernias comprise about 5–10% of all hiatal hernias. Majority of patients are asymptomatic while some may present with reflux symptoms, obstruction or bleeding. There are numerous controversies on the indications of surgery, operative approach, hernial sac excision, fundoplication and on the use of a mesh. Methods We present a series of 3 patients with giant paraesophgeal hernia diagnosed in year 2020 in our institution, followed by a literature review. This study aims to assess the indications and effectiveness of laparoscopic paraesophageal hernia repair with routine sac excision, primary crural repair and fundoplication in the treatment of giant paraesophageal hernia. Results There were 3 patients in this study. Their mean age was 49. All patients had type IV hiatal hernia and the mean hernia defect was 8 cm in diameter. Laparoscopic paraesophageal hernia repair, sac excision and anterior 180 degree fundoplication was successfully done for all patients without conversion to open surgery. There was no intraoperative or post-op complications. Mean length of stay post-op was 2 days. At one year follow-up, all patients achieved complete resolution of symptoms without new onset reflux or dysphagia. Conclusion Laparoscopic paraesophageal hernia repair with routine sac excision, primary crural repair and fundoplication is safe and effective in treating giant paraesophageal hernias. Tension free repair is the key to success. A 180-degree anterior partial wrap may be able to reduce the incidence of dysphagia.

Use of Polypropylene Strips for Reinforcement of the Cruroplasty in Laparoscopic Paraesophageal Hernia Repair: A Retrospective Cohort Study

<b><i>Introduction:</i></b> Laparoscopic paraesophageal hernia repair is an effective treatment for symptomatic paraesophageal hernias. To reduce recurrence rates, the use of prosthetics for the crural repair has been suggested. Mesh-related complications are rare but known to be disastrous. To address another form of crural repair, polypropylene strips are suggested. This study aimed to assess peri- and postoperative complications of reinforcement of cruroplasty with polypropylene strips. <b><i>Methods:</i></b> From 2013 to 2020, patients with a primary or recurrent type 2, 3, or 4 paraesophageal hernia that underwent cruroplasty with polypropylene strips were retrospectively reviewed. Intra- and postoperative complications were graded according to the Clavien-Dindo classification. The incidence of symptomatic recurrent hiatal hernia (CT or endoscopy proven) and hospital stay were assessed. <b><i>Results:</i></b> One hundred fifty-eight patients were included. Mean age was 65 years (standard deviation 10.4), and 119 patients were female (75.3%). Almost 50% of surgeries took place between 2018 and 2020. Median follow-up was 7 months (interquartile range 17.5). Mean operation time in the primary hernia group was 159 min (standard deviation 39.0), and length of stay was 4.4 days. In 3/158 patients (2.0%), intraoperative complications occurred. Two patients developed a grade 4 and seven patients a grade 3 postoperative complication. No mortality was recorded. Twelve recurrences (8.2%) were detected in the primary hernia group and one (9.1%) in the recurrent hernia group. <b><i>Conclusion:</i></b> There were no mesh-related complications seen and symptomatic recurrence rate was low, but longer follow-up is needed.

Postoperative atrial fibrillation in paraesophageal hernia repair: can it be prevented?

Acute ischemic thromboembolic stroke is one of the most feared complications of atrial fibrillation (AF), and the risk increases with higher CHA2DS2-VASc scores. Postoperative atrial fibrillation (POAF) is common after noncardiac surgery, particularly after thoracic surgery, and can result in significant morbidity and mortality. We report the case of an 85-year-old female with a history of untreated hypertension (HTN) and no prior history of AF, who presented 5 days after an elective repair of a paraesophageal hernia with recurrence of a large type III paraesophageal hiatal hernia, AF, and subsequent acute thromboembolic ischemic stroke. Patient’s AF resolved shortly after treatment with calcium channel blocker. The risk of stroke is high in patients who develop AF and a period of 48 h after onset of AF is usually considered safe as the risk of stroke is low in this time period. However, this may not be the case during the perioperative period and preventive measures such as preoperative calcium channel blocker could be considered. Our case highlights that acute ischemic thromboembolic stroke might develop earlier tha 48 h after onset of POAF in patients undergoing paraesophageal hernia repair. Initiation of a calcium channel blocker should be considered during preoperative evaluation for patients undergoing paraesophageal hernia repairs, especially in those with untreated HTN.