Patient Factors Influencing Surgical Technique in Hiatal Hernia Repair: In Search for Surgeons' Hidden Algorithm

Area of Science:

• Gastroenterology
• Surgical Innovation
• Hernia Repair

Background:

• Laparoscopic fundoplication is the standard surgical approach for hiatal hernia (HH) repair.
• Reinforcement techniques such as anterior sutures, vertical mesh strips (VMS), or mesh placement can be employed.
• Understanding patient factors influencing technique selection is crucial for optimizing surgical outcomes.

Purpose of the Study:

• To investigate the association between patient characteristics and the choice of reinforcement techniques in laparoscopic hiatal hernia repair.
• To identify specific patient factors that guide the selection of sutures, VMS, or mesh during HH repair.

Main Methods:

• Retrospective cohort study of 307 patients undergoing laparoscopic HH repair between 2012 and 2019.
• Hiatal hernias were measured using CT scans.
• Patient demographics, clinical data, and surgical details, including reinforcement methods, were collected and analyzed.

Main Results:

• Anterior sutures were associated with female gender, higher HH type, and older age.
• Vertical mesh strips (VMS) were linked to higher HH type, older age, and larger transverse HH diameter.
• Mesh reinforcement correlated with higher HH type and larger transverse HH diameter.

Conclusions:

• Surgical reinforcement techniques for hiatal hernias are significantly influenced by patient factors including gender, body metrics, HH type, and transverse diameter.
• Patient age emerged as an unexpected but significant factor in reinforcement technique selection.