Is repairing giant hiatal hernia in patients over 80 worth the risk?

Abstract

Patients with giant hiatal hernia (GHH) are often symptomatic and have significantly reduced quality of life (QoL). Advanced age is a predictor of increased morbidity and mortality in open hiatal surgery, however, outcomes of laparoscopic surgery in patients over the age of 80 are limited to case reports and small case series.Data was extracted from a prospectively maintained database. Consecutive patients over the age of 80 with GHH that have undergone surgery were included. Peri-operative mortality, complications, recurrence rates, use of acid suppressive medication and QoL was analysed. Search of Ryerson index was performed to determined post-operative survival.Inclusion criteria were met by 89 patients. Mean age was 84 (80–93). The mean volume of herniated stomach was 70.9% range 30–100%; SD 27.25). There was one death in this cohort on day 30 from myocardial infarction and one mediastinal collection requiring percutaneous radiological drainage and antibiotics. There were no other major complications (Clavien-Dindo Grade III-IV). Mean post-operative survival was 74.5 months (SD 47.8). GIQLI was reduced pre-operatively (mean 91.8; SD 19.4). There was significant improvement in GIQLI scores at early (mean 101.45; SD 21.2) and late (mean 106.7; SD 19.2) post-operative follow-up (p = 0.005). Pre-operative Visick scores (mean 2.92; SD 0.98) have improved significantly in early (mean 1.94; SD 0.97; p = 0.000) and late (mean 2.03; SD 0.99; p = 0.001) post-operative periods. Satisfaction with surgery was 97% during early and 93.3% during late post-operative follow up.Laparoscopic repair of GHH in appropriately selected elderly patients is safe and results in significant improvement in quality of life.