Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic Hiatal Hernia Repair in the Elderly Patient

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 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 3:245–248

    Article  Google Scholar 

  2. 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

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  6. 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:S885

    Article  Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. 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 18:444–447

    Article  CAS  PubMed  Google Scholar 

  9. 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 18:1045–1050

    Article  CAS  PubMed  Google Scholar 

  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:S619

    Article  Google Scholar 

  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 16:453–459

    Article  PubMed  Google Scholar 

  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 140:491–499

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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 93:351–353

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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 13:838–842

    Article  CAS  PubMed  Google Scholar 

  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 156:352–360

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  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 12:1888–1892

    Article  PubMed  Google Scholar 

  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:S851

    Article  Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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 77:1353–1357

    PubMed  Google Scholar 

  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 21:63–68

    CAS  PubMed  Google Scholar 

  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 19:4–8

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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.e1

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

Download references

Authors contributions

J.E. Oor, J.H. Koetje, D.J. Roks, V.B. Nieuwenhuijs, and E.J. Hazebroek were involved in the study concept and design, interpretation of data and drafting, and critical revisions of the manuscript. J.E. Oor and J.H. Koetje were also involved in the acquisition, analysis, and interpretation of the data. E.J. Hazebroek was the study supervisor. All authors approved the final version of the manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands

    J. E. Oor, D. J. Roks & E. J. Hazebroek

  2. Department of Surgery, Isala Clinics, Zwolle, The Netherlands

    J. H. Koetje & V. B. Nieuwenhuijs

Authors
  1. J. E. Oor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. H. Koetje
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. J. Roks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. B. Nieuwenhuijs
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. J. Hazebroek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. E. Oor.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oor, J.E., Koetje, J.H., Roks, D.J. et al. Laparoscopic Hiatal Hernia Repair in the Elderly Patient. World J Surg 40, 1404–1411 (2016). https://doi.org/10.1007/s00268-016-3428-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-016-3428-y

Keywords

Search

Navigation