Abstract
IntroductionLarge esophageal hiatal hernias occur most commonly in elderly patients with comorbidities, in whom even an elective surgery cannot be performed without high risks. Although fundoplication is recommended for esophageal hiatal hernia repair, we prefer not to limit our options to fundoplication, as obstruction is a frequent main complaint. We favor an anterior gastropexy approach instead to perform anti-reflux surgery and prevent recurrent protrusion and torsion of the incarcerated organ with minimal risk. The aim was to evaluate the safety and effectiveness of anterior gastropexy for large hiatal hernia in elderly patients with comorbidities.Case presentationWe retrospectively evaluated 8 patients who underwent laparoscopic anterior gastropexy for large hiatal hernia (type III or IV) since 2006. All patients were women with a median age of 82 years (range, 74–87 years). The major complaint was obstruction in all patients, with relatively mild reflux symptoms. They underwent successful laparoscopic surgery with no conversion to laparotomy.Fundoplication was performed in 4 cases. No perioperative complications occurred, and the main complaint resumed rapidly in all patients, without recurrence during postoperative follow-up of median 48 months (range, 5–77 months).ConclusionLaparoscopic anterior gastropexy is safe and effective and can be considered as one of the practical surgical options for large hiatal hernias in elderly patients, whom surgical intervention should be minimized due to their comorbidities.
Highlights
Large esophageal hiatal hernias occur most commonly in elderly patients with comorbidities, in whom even an elective surgery cannot be performed without high risks
Case presentation: We retrospectively evaluated 8 patients who underwent laparoscopic anterior gastropexy for large hiatal hernia since 2006
As large hiatal hernias most commonly occur in elderly female patients with comorbidities and lumbar kyphosis in Japan, even an elective surgery cannot be performed without high risks [1,2,3]
Summary
Large esophageal hiatal hernias occur most commonly in elderly patients with comorbidities, in whom even an elective surgery cannot be performed without high risks. As large hiatal hernias most commonly occur in elderly female patients with comorbidities and lumbar kyphosis in Japan, even an elective surgery cannot be performed without high risks [1,2,3]. Lumbar kyphosis was observed in 6 cases Their major preoperative complaint was obstruction, with mild reflux symptoms in all patients. Their comorbidities were shown in Table 1: hypertension (4 cases), coronary artery disease (2), rheumatoid arthritis (1), abdominal aortic aneurysm (1), and amyotrophic lateral sclerosis (with duplicates) (1). The median duration of the symptoms was 12 months (range, 6–36 months)
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