AB104. SOH24AB_054. Reducing recurrence rates in hiatal hernia repair: results of a quality improvement study

Background: Laparoscopic repair with fundoplication is the approach of choice for treatment of symptomatic hiatal hernias. Patient and procedure factors are considered in the decision-making process repair. Recurrence is multi-factorial and has been shown to be related to size, type, body mass index (BMI), and age. This study examined recurrence rates in our institution, identified areas for improvement in surgical technique, and re-assessed recurrence following implantation of a quality improvement initiative.

Methods: A retrospective review of patients undergoing hiatal hernia repair surgery between 2018–2022 was conducted in our high-volume tertiary care centre. Descriptive analysis was performed using Pearson’s chi squared and student’s t-test. Regression analysis evaluated recurrence association against independent variables such as patient demographics, pre-operative characteristics, and intra-operative technique.

Results: In total, 75 patients from 2018–2020 and 34 patients from 2021–2022 were identified. The recurrence rate was 21% in 2018–2020, with 14% requiring a revisional procedure. Recurrence and re-operation was subsequently reduced to 6% in 2021 and 2022, which was statistically significant (P=0.043). There was an increase in gastropexy from 21% to 41% following the review (P=0.032), mainly reserved for large and giant hernias. Procedural review and gastropexy can be attributed to recurrence rate reduction.

Conclusions: It is important to educate patients on the likelihood and risk factors of recurrence. A comprehensive review of procedures and a quality improvement program for hiatal hernia repair in our facility has been demonstrated to reduce recurrence.

Keywords: Hiatal hernia; paraoesophageal hernia; gastropexy; recurrence; fundoplication