Giant hiatus hernia (GHH) is usually symptomatic and can have significant impact on a patient’s quality of life. There is ongoing debate about optimal technique of giant hiatus hernia repair. This paper aims to look at the outcomes of laparoscopic composite repair of giant hiatus hernia from a large single centre cohort. Methods A retrospective analysis of prospectively maintained database was performed. Patients undergoing composite repair for GHH defined as >30% stomach above diaphragm were included. Primary outcome was hernia recurrence. Secondary outcomes were perioperative morbidity and mortality, correlation of symptoms and hernia recurrence post operatively, need for revision surgery, resolution of symptoms post operatively and patient self-reported quality of life (GIQOL, Visik score). Results Inclusion criteria were met by 221 patients. Post-operative endoscopic and/or barium swallow follow up was performed in 198 patients with 23.74% recurrence rate. There was no correlation with recurrence of hernia and persistent post-operative symptoms. The most common presenting symptom was shortness of breath, followed by dysphagia, chest pain and heartburn. Dysphagia was most common post-operative symptom. There was significant improvement in QOL post-operatively. Conclusion Laparoscopic composite repair was proven safe and effective in this cohort. Hernia recurrence was not associated with ongoing symptoms and did not have an effect on QOL. A small proportion of patients with recurrence required revision surgery. Overall satisfaction with surgery was high.

Aim The aim of this study was to assess the perioperative pathway and outcomes of trauma laparotomy during a one-year period in a newly established Major Trauma Centre in Northern Ireland. Method Retrospective review of a trauma registry undertaken at the Belfast Royal Victoria Hospital between August 2019 and August 2020. Results During this one-year period, there were a total of 17 trauma laparotomies, with a female-to-male ratio of 6:11, and a mean age of 38.9 years. 15 of 17 cases were due to blunt trauma, with only 2 cases of penetrating trauma. Of trauma laparotomies, 8 were performed during day-time hours (0801-1800), 4 during evening-hours (1801-0000), and 5 during night-time hours (0001-0800). One perioperative death was recorded. The mean time to CT from arrival to ED was 34 minutes (national target of 30 minutes). The mean time until final report was 477 minutes (national target of < 24 hours). The decision to proceed to trauma laparotomy was made prior to the final report in 9 cases. The mean length of inpatient stay for trauma laparotomy patients was 23.3 days, with a mean of 8.9 days spent in critical care. Conclusions This review provides an overview of provision of care for patients who underwent trauma laparotomies in Royal Victoria Hospital MTC and identifies areas for improvement. We plan to prospectively review outcomes following the opening of the Major Trauma Ward on 7th September 2020 and the implementation of the Northern Ireland Major Trauma Network Bypass protocol on 26th October 2020.