One hundred percent Follow up of a case series of patients operated upon for type II-IV Hiatus Hernia(II-IV HH) in the arch of 30 years..

Background: Medical and surgical literature often points out the risk of bias in interpreting results of GERD-HH surgery because of the frequent incompleteness and relatively short time of post operative follow up. Because of the peculiarity of the Italian NHS and society (low % of migration), we have the opportunity to report on a case series totally followed up according to a protocol for an unusually long time. Methods: 66 patients (median age 67.5 years) (41 women, 25 men) with II-IV HH underwent surgery from 1980 to 1994 with the “open” surgical approach and 34 (median age 69 years) (26 women, 8 men) in the period 1995–2010 with minimally invasive techniques. Patients at given time underwent interview, barium swallow and endoscopy. Results were considered poor in case of relapse of symptoms, endoscopic esophagitis any grade, hiatus hernia, post operative antirefl ux medical therapy. Follow up time was calculated from surgery to the last complete follow up. Results: The cumulative post-operative mortality was 3/100, 97 patients were followed up for a median period of 96 months (IQR 25.5–201) : 12 months, 11 patients; 13–36 months, 8 patients; 37–60 months, 17 patients; 61–120 months, 22 patients; 121–216 months, 22 patients; and 217–440 months, 17 patients. Hiatal hernia (HH) relapse occurred in 6/97 (6.2%). Satisfactory results were obtained in 92.8%, excellent in 39.2%, good in 43.2%, fair in 10.4%, and poor in 7.2% (6 HH relapse, 1 esophagitis without HH relapse). Discussion: Surgery for type II-IV hiatal hernia may be objectively satisfactory after years decades. Disclosure: All authors have declared no confl icts of interest.