OA10.7. Surgical Management of Giant Hiatus Hernias Presenting as an Emergency: Experience From a Single High Volume Tertiary OG Centre

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ID: 325931
2026
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Ranked #206 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Background Acute presentation of Giant hiatus hernias with obstruction or gastric volvulus is a potentially life threatening condition. There is a paucity of data within the literature for the best management of this uncommon condition. We report our outcomes at a high-volume tertiary esophagogastric centre in the United Kingdom. Methods After excluding elective cases, paediatric cases, traumatic or congenital diaphragmatic hernias, and paraconduit hernias, a total of ninety patients with an emergency presentation of complicated hiatal hernias between January 2016 and May 2024 were identified from theatre records. These were cross checked with our returns to theatre database, and individual consultant databases. All patients underwent diagnostic evaluation with computed tomography. A retrospective analysis was performed, capturing demographic characteristics, comorbidities (ASA), radiological findings, operative approach and postoperative outcomes, including in-hospital recurrence and in hospital mortality. Results Ninety patients presented with acute complicated hiatus hernia between 2016 and 2024, with a mean age of 72 years and predominance of obstructive symptoms (70%). CT imaging confirmed type III hernias were the most common (46.7%), and gastric volvulus was present in 62.2%. Transfer from peripheral hospitals occurred in 62%. Surgery was completed laparoscopically in (58.9%), with 14.4% laparoscopic converted to open and 26.7% performed open primarily. Six patients (6.7%) had ischaemic stomachs requiring resection. Fundoplication with added gastropexy were undertaken in 75.6% of patients. Median time to surgery was one day and mean operative time 219 minutes. Mean length of stay was 12.2 days. Reoperation occurred in ten patients (11.1%) including early recurrence (n=2), delayed reconstruction (n=3), chyle leak (n=1), bleeding (n=1), delayed colonic ischaemia (n=2), and oesophageal injury (n=1). Thirty-day mortality was 5.6%, predominantly associated with gastric necrosis. Conclusion Emergency repair of complicated hiatal hernias can be performed safely during the index admission in high-volume tertiary OG centres, even in elderly patients with significant comorbidity. Early operative intervention yields acceptable morbidity and mortality, with most deaths related to gastric ischaemia. Combined crural repair, fundoplication and gastropexy is our preferred technique associated with low recurrence and minimal mesh use. These findings support early transfer to, and early surgery within, a tertiary specialist OG centre.
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Authors Simon L. Parsons, Ahmed A S Alattar, Stephen Lam, Nur Aliah Mahadir, Raffi Habib, Neil T. Welch
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.070
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.070/70760604/doag077.070.pdf
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