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World Journal of Surgery

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01-06-2016 | Original Scientific Report

Laparoscopic Hiatal Hernia Repair in the Elderly Patient

Authors: J. E. Oor, J. H. Koetje, D. J. Roks, V. B. Nieuwenhuijs, E. J. Hazebroek

Published in: World Journal of Surgery | Issue 6/2016

Abstract

Background

Hiatal hernias (HH) are more common among elderly patients, with an increase in incidence with advancing age. Elderly patients frequently suffer from comorbidity, causing them to have an increased risk of perioperative mortality and morbidity. The aim of this study is to assess the safety of this procedure within elderly patients.

Methods

We performed a retrospective analysis of all patients with HH operated between July 2009 and May 2015 at two hospitals in the Netherlands specialized in antireflux surgery and HH repair. Mortality rates and short- and long-term morbidity rates were compared between patients aged under 70 years and aged over 70 years.

Results

A total of 204 consecutive patients underwent laparoscopic HH repair at our institutions, of whom 121 were aged under 70 years and 83 were aged over 70 years. There was no mortality intraoperatively, nor during 30-days follow-up. Intraoperative complications occurred in 7 patients aged 70 years and over, with no significant differences compared to the patients aged under 70. The 30-day morbidity rate did not significantly differ between the age groups, with an overall postoperative complication rate of 9.3 %. Only length of stay (LOS) was significantly longer in the elderly patients. Performing univariate analysis, only the occurrence of intraoperative complications was associated with 30-day morbidity.

Conclusion

In the present study, age was not associated with increased 30-day morbidity or mortality following HH repair. Therefore, in carefully selected patients, age should not be used as an argument to withhold laparoscopic HH repair.

Klein T, Semaan A, Kellner M, Ritgen J, Boemers TM, Stressig R (2015) Coincidence of congenital left-sided diaphragmatic hernia and ductus venosus agenesis: relation between altered hemodynamic flow and lung-to-head-ratio? J Pediatr Surg Case Rep 3:245–248CrossRef

Tay CKJ, Teoh HL, Su S (2015) A common problem in the elderly with an uncommon cause: hypoglycaemia secondary to the Doege-Potter syndrome. BMJ Case Rep. doi:10.1136/bcr-2014-207995

Grotenhuis BA, Wijnhoven BPL, Bessell JR, Watson DI (2008) Laparoscopic antireflux surgery in the elderly. Surg Endosc Interv Tech 22:1807–1812CrossRef

Lal DR, Pellegrini CA, Oelschlager BK (2005) Laparoscopic repair of paraesophageal hernia. Surg Clin North Am 85:105–118CrossRefPubMed

Evers BM, Townsend CM Jr, Thompson JC (1994) Organ physiology of aging. Surg Clin North Am 74:23–39PubMed

Rezaie A, Hom C, Huang L, Chang C, Chua KS, Pimentel M (2015) Physiologic esophageal length in adults is associated with gender and presence of hiatal hernia but not with age. Gastroenterology 148:S885CrossRef

Perdikis G, Hinder RA, Filipi CJ, Walenz T, McBride PJ, Smith SL, Katada N, Klingler PJ (1997) Laparoscopic paraesophageal hernia repair. Arch Surg 132:586–589 discussion 590–1 CrossRefPubMed

Andujar JJ, Papasavas PK, Birdas T, Robke J, Raftopoulos Y, Gagne DJ, Caushaj PF, Landreneau RJ, Keenan RJ (2004) Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc 18:444–447CrossRefPubMed

Targarona EM, Novell J, Vela S, Cerdan G, Bendahan G, Torrubia S, Kobus C, Rebasa P, Balague C, Garriga J, Trias M (2004) Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia. Surg Endosc 18:1045–1050CrossRefPubMed

10.

Sugimoto M, Sahara S, Ichikawa H, Uotani T, Yamade M, Kagami T, Sugimoto K, Furuta T (2015) Efficacy of surgical spinal correction in patients with severe spinal kyphotic deformity for gastroesophageal reflux disease and bowel habi. Gastroenterology 148:S619CrossRef

11.

Oelschlager BK, Petersen RP, Brunt LM, Soper NJ, Sheppard BC, Mitsumori L, Rohrmann C, Swanstrom LL, Pellegrini CA (2012) Laparoscopic paraesophageal hernia repair: defining long-term clinical and anatomic outcomes. J Gastrointest Surg 16:453–459CrossRefPubMed

12.

Gangopadhyay N, Perrone JM, Soper NJ, Matthews BD, Eagon JC, Klingensmith ME, Frisella MM, Brunt LM (2006) Outcomes of laparoscopic paraesophageal hernia repair in elderly and high-risk patients. Surgery 140:491–499CrossRefPubMed

13.

Larusson HJ, Zingg U, Hahnloser D, Delport K, Seifert B, Oertli D (2009) Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity. World J Surg 33:980–985. doi:10.1007/s00268-009-9958-9 CrossRefPubMed

14.

Furnee EJ, Draaisma WA, Gooszen HG, Hazebroek EJ, Smout AJ, Broeders IA (2011) Tailored or routine addition of an antireflux fundoplication in laparoscopic large hiatal hernia repair: a comparative cohort study. World J Surg 35:78–84. doi:10.1007/s00268-010-0814-8 CrossRefPubMedPubMedCentral

15.

Trus TL, Laycock WS, Wo JM, Waring JP, Branum GD, Mauren SJ, Katz EM, Hunter JG (1998) Laparoscopic antireflux surgery in the elderly. Am J Gastroenterol 93:351–353CrossRefPubMed

16.

Tedesco P, Lobo E, Fisichella PM, Way LW, Patti MG (2006) Laparoscopic fundoplication in elderly patients with gastroesophageal reflux disease. Arch Surg 141:289–292 discussion 292 CrossRefPubMed

17.

Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ (1999) Is laparoscopic antireflux surgery for gastroesophageal reflux disease in the elderly safe and effective? Surg Endosc 13:838–842CrossRefPubMed

18.

Molena D, Mungo B, Stem M, Feinberg RL, Lidor AO (2014) Outcomes of operations for benign foregut disease in elderly patients: a National Surgical Quality Improvement Program database analysis. Surgery 156:352–360CrossRefPubMed

19.

Allaix ME, Patti MG (2013) Laparoscopic paraesophageal hernia repair. Surg Laparosc Endosc Percutan Tech 23:425–428CrossRefPubMed

20.

Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236:492–500 discussion 500–1 CrossRefPubMedPubMedCentral

21.

Poulose BK, Gosen C, Marks JM, Khaitan L, Rosen MJ, Onders RP, Trunzo JA, Ponsky JL (2008) Inpatient mortality analysis of paraesophageal hernia repair in octogenarians. J Gastrointest Surg 12:1888–1892CrossRefPubMed

22.

Louie BE, Blitz M, Orlina J, Farivar A, Aye RW (2010) Repair of symptomatic giant paraesophageal hernias in elderly (>70 Yrs) patients results in improved quality of life. Gastroenterology 138:S851CrossRef

23.

Bawahab M, Mitchell P, Church N, Debru E (2009) Management of acute paraesophageal hernia. Surg Endosc Interv Tech 23:255–259CrossRef

24.

Patti MG, Fisichella PM (2009) Laparoscopic paraesophageal hernia repair. How I do it. J Gastrointest Surg 13:1728–1732CrossRefPubMed

25.

Ballesta Lopez C, Cid JA, Poves I, Bettonica C, Villegas L, Memon MA (2003) Laparoscopic surgery in the elderly patient. Surg Endosc 17:333–337CrossRefPubMed

26.

Weber DM (2003) Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg 138:1083–1088CrossRefPubMed

27.

Nguyen NT, Christie C, Masoomi H, Matin T, Laugenour K, Hohmann S (2011) Utilization and outcomes of laparoscopic versus open paraesophageal hernia repair. Am Surg 77:1353–1357PubMed

28.

Karmali S, McFadden S, Mitchell P, Graham A, Debru E, Gelfand G, Graham J, Martin S, Tiruta C, Grondin S (2008) Primary laparoscopic and open repair of paraesophageal hernias: a comparison of short-term outcomes. Dis Esophagus 21:63–68PubMed

29.

Ferri LE, Feldman LS, Stanbridge D, Mayrand S, Stein L, Fried GM (2005) Should laparoscopic paraesophageal hernia repair be abandoned in favor of the open approach? Surg Endosc 19:4–8CrossRefPubMed

30.

Nissen R (1955) Hiatus hernia and its surgical indication. Dtsch Med Wochenschr 80:467–469CrossRefPubMed

31.

Nissen R (1956) Gastropexy as the lone procedure in the surgical repair of hiatus hernia. Am J Surg 92:389–392CrossRefPubMed

32.

Luketich JD, Nason KS, Christie NA, Pennathur A, Jobe BA, Landreneau RJ, Schuchert MJ (2010) Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 139:395–404.e1CrossRefPubMedPubMedCentral

33.

Auyang ED, Pellegrini CA (2012) How I do it: laparoscopic paraesophageal hernia repair. J Gastrointest Surg 16:1406–1411CrossRefPubMed

34.

Targarona EM, Balague C, Martinez C, Garriga J, Trias M (2004) The massive hiatal hernia: dealing with the defect. Semin Laparosc Surg 11:161–169PubMed

35.

Horgan S, Eubanks TR, Jacobsen G, Omelanczuk P, Pellegrini CA (1999) Repair of paraesophageal hernias. Am J Surg 177:354–358CrossRefPubMed

36.

Casabella F, Sinanan M, Horgan S, Pellegrini CA (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 171:485–489CrossRefPubMed

Title: Laparoscopic Hiatal Hernia Repair in the Elderly Patient
Authors: J. E. Oor
J. H. Koetje
D. J. Roks
V. B. Nieuwenhuijs
E. J. Hazebroek
Publication date: 01-06-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 6/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3428-y

At a glance: The STEP trials

Springer Medicine

Laparoscopic Hiatal Hernia Repair in the Elderly Patient

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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