SAGES 2026 Annual Meeting Emerging Technology Session

INTRODUCTION

Hiatal hernia is a condition in which abdominal viscera protrude through the esophageal hiatus of the diaphragm and into the mediastinum
Patients with hiatal hernias may present with a variety of upper gastrointestinal (GI) symptoms including heartburn, dyspepsia, nausea, vomiting, and bloating
Many patients with these same upper GI symptoms are found to have delayed gastric emptying on scintigraphy
Given the prevalence of patients with altered GI motility, patients with a symptomatic hiatal hernia who may benefit from surgical repair may also have evidence of altered gastric motility
There are no established guidelines directed towards hiatal hernia repair in patients with evidence of delayed gastric emptying
Goal: To compare postoperative outcomes between patients with abnormal and normal gastric emptying studies (GES) following hiatal hernia repair

METHODS AND PROCEDURES

Dual-center retrospective cohort study
Inclusion criteria: Patients 18 years of age and older who underwent preoperative gastric emptying scintigraphy (GES) and subsequent hiatal hernia repair
Exclusion criteria: Patients who had undergone previous foregut or anti-reflux surgery, patients with missing preoperative data or had no recorded postoperative data at any time-point
Data was collected using the Registry of Outcomes from Anti-Reflux Surgery (ROARS) questionnaire
Outcomes categorized as short-term (3-6 months) and long-term (1-3 years)
Outcomes assessed include dysphagia, regurgitation, Health-Related Quality of Life (HRQL), vomiting, and gas-bloat
Patients with delayed GES were matched to patients with normal GES based on age, hiatal hernia size, and body mass index (BMI)

RESULTS

There were no statistically significant differences in ROARS scores between patients with normal and delayed gastric emptying for any of the factors studied at either postoperative timepoint (Figure 1a-b)
There were statistically significant differences in scores from preoperative to short-term follow-up for HRQL (p=0.008), regurgitation (p=0.016), and vomiting (p=0.004) and for preoperative to long-term follow-up for HRQL (p=0.014) and regurgitation (P=0.009). (Figure 2a) in the normal gastric emptying group.
There were statistically significant improvements in scores from preoperative to short-term follow-up in HRQL (p=0.005) and regurgitation (p=0.023). and from preoperative to long-term follow-up in HRQL (P=0.035) and regurgitation (p=0.038) (Figure 2b) for the delayed gastric emptying group

CONCLUSION

Patients with preoperative evidence of delayed gastric emptying have similar outcomes after hiatal hernia repair as compared to patients with normal gastric emptying in both short and long-term time intervals.
Patients with evidence of delayed gastric emptying prior to hiatal hernia repair experience a significant improvement in their symptoms after repair
A larger cohort of patients is needed to potentially see differences in short and long-term outcomes between patients with normal and delayed gastric emptying

COMPARING POSTOPERATIVE OUTCOMES BETWEEN PATIENTS WITH NORMAL AND ABNORMAL GASTRIC EMPTYING STUDIES FOLLOWING HIATAL HERNIA REPAIR