383. OUTCOMES OF ELECTIVE REPAIR OF VERY LARGE HIATUS HERNIAS IN THE MORBIDLY OBESE

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Abstract Background Obesity is a risk factor for the development of a large hiatus hernia. Such hernias are often symptomatic and can negatively impact quality of life. However, surgeons can be reluctant to operate on obese patients due to concerns of increased operative complexity, early hernia recurrence and increased perioperative morbidity. To evaluate this, we assessed the perioperative risks and short-term clinical outcomes following large hiatus hernia repair in obese and morbidly obese patients. Methods Patients who underwent repair of a very large hiatus hernia (3 50% intrathoracic stomach) from January 2000—December 2023 were identified from a prospective database. Patients were categorised based on body mass index into 3 groups: non-obese (BMI < 30.0), obese (BMI 30.0–34.9) and morbidly obese (BMI 3 35.0). Perioperative and early postoperative clinical outcomes were compared. Results 915 patients were included (non-obese: 519 [56.7%], obese: 276 [30.1%], morbidly obese: 120 [13.1%]). Morbidly obese patients were younger (69.2 vs 65.8 vs 64 years) and more likely to be female (60.9% vs 79.7% vs 83.9%, p < 0.001). There were no differences in operative time (106.4 vs 103.4 vs 113.6 minutes) or length of stay (2.8 vs 2.48 vs 2.57 days). We found no differences in major complication (4.0% vs 2.9% vs 1.7%) or return to theatre rates (2.7 vs 1.1 vs 1.7%). There was a significant improvement in symptom severity and overall satisfaction was high (8.72 out of 10). Conclusion Repair of symptomatic large hiatus hernias is safe and effective in obese and morbidly obese populations.

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