OC-052 A CHANGE IN PRESENTATION OF PARAOESOPHAGEAL HIATUS HERNIA REQUIRING SURGICAL INTERVENTION IN A DISTRICT GENERAL HOSPITAL IN THE NORTHERN REGION OF THE UNITED KINGDOM

Aim

The incidence of paraoesphageal hiatus hernia (PEH) has changed over the last several years. This study aims to ascertain the difference in the presentation of PEH requiring operative intervention at our unit because of the COVID-19 pandemic

Material & Methods

We conducted a retrospective review of procedures performed by a single surgeon for PEH in a district general hospital. We compared cases from 2016 to March 2020 and during the initial period of the COVID-19 pandemic in 2020.

Results

39 consecutive cases were identified undergoing PEH related procedures. The median age was 66 (IQR 26), with slight female predominance (M:F ratio of 5:6). 28 cases (71.8%) were performed as elective cases.

After the 2020 March lockdown, there were 10 cases of PEH repair performed with 78% performed as emergency procedures, compared to 30 cases in the preceding 5 years and 10% performed as emergency cases. Chi-square test to examine the association between COVID-19 pandemic and emergency procedure, X2(1, N=39)=14.199, p=0.000164.

Pre-COVID19 the types of procedures included 76.7% were fundoplication with suture crural closure, 10% were fundoplication with mesh repair, 3.3% biological mesh repair, 3.3% with suture closure of the crural and 6.7% had suture gastropexy. During the COVID-19 period, 44.4% were gastropexy, 33.3% were gastrostomy tube insertion and 22.2% fundoplication performed.

Conclusion

We have seen significantly more emergency PEH related procedures performed and using a variety of procedures. This leads to the consideration of whether current emergency general surgery training can equip trainees for future independent practice.

Nonagenarian surgical admissions for the acute abdomen: who benefits?

INTRODUCTION

Patients 90 years and older form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented.

METHODS AND MATERIALS

Surgical management of 49 consecutive nonagenarian admissions (median age: 92 years) with an acute abdomen was compared with the management and outcome of 50 younger patients (median age: 53.5) admitted with a suspected acute abdomen over the same period.

RESULTS

Nonagenarian group consisted of mainly women (71% vs. 50%; p = 0.003). The use of laboratory investigations and imaging was similar for the patients aged over 90 and the younger patients, although proportionately fewer nonagenarians were investigated by abdominal CT scan (8% vs. 24%). Of the 49 nonagenarian patients admitted, only 4% (n = 2) were operated on. In contrast, 38% (n = 19) of patients aged 50-59 (p = 0.0001) underwent a surgical intervention. A much greater proportion of nonagenarians died in hospital than patients in the 50-59 comparator group (16% nonagenarians vs. 4% comparator patients; p = 0.04). The very large majority of survivors in both age groups were discharged back to their preadmission domicile [39 (95%) nonagenarians vs. 46 (96%) comparator 50-59 year group].

CONCLUSIONS

In this study, when compared with younger patients, very few nonagenarian patients (2%) with a suspected acute abdomen benefited from surgical admission. Instead, the large majority of nonagenarians either died or were discharged back to their home address without surgery.