Patient factors influencing surgical technique in hiatal hernia repair: in search for surgeons' hidden algorithm.

Introduction: Laparoscopic fundoplication is the current standard for HH repair. HH repair can be reinforced with additional anterior sutures, vertical mesh strips (VMS) or mesh placement. We analyzed the influence of patient factors on the surgical technique for laparoscopic repair in a teaching hospital.

Methods: Between 2012-2019, all patients who underwent repair of HH were assessed in this retrospective cohort study. HH was measured on CT scans and baseline patient characteristics and surgical details were collected.

Results: In total, 307 patients were included. 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of anterior sutures in 132 patients, VMS in 89 patients and mesh in 17 patients. The use of anterior sutures was significantly associated with female gender, higher type of HH and higher age. The use of VMS during surgery was significantly associated with higher type of HH, higher age and larger transverse diameter of the HH. The use of mesh during surgery was significantly associated with higher type of HH and larger transverse diameter of the HH.

Conclusion: In this retrospective study, the reinforcement techniques used during surgery were significantly associated with patient factors such as gender, body length and weight, type of HH and transverse diameter. An unexpected patient associated factor was age.