Laparoscopic paraesophageal hernia repair: quality of life outcomes in the elderly

Abstract

Paraesophageal hernias (PEH) occur when there is herniation of the stomach through a dilated hiatal aperture. These hernias occur more commonly in the elderly, who are often not offered surgery despite the failure of medical treatment to address mechanical symptoms and life-threatening complications. The aim of this study was to assess the impact of laparoscopic repair of PEH on quality of life in an elderly population. Data were collected prospectively on 35 consecutive patients aged >70 years who had laparoscopic repair of a symptomatic PEH between December 2001 and September 2005. The change in quality of life was assessed using a validated questionnaire, the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), and by patient interviews. Patients were assessed preoperatively, and at 6 weeks, 6 months, 12 months, 1 year, and 2 years postoperatively. Mean patient age was 77 years (range 70-85); mean American Society of Anesthesiologists class was 2.7 (range 1-3). There were 28 women and 7 men. There was one readmission for acute reherniation, which required open revision. Total complication rate was 17.1%. All complications were treated without residual disability. There was no 30-day mortality, and median hospital stay was 3 days (range 2-14). Completed questionnaires were obtained in 30 of 35 patients (85.7%). There was a significant improvement in quality of life, as measured with QOLRAD, at all postoperative time points (P < 0.001). Laparoscopic PEH repair can be performed with acceptable morbidity in symptomatic patients refractory to conservative treatment and is associated with a significant improvement in quality of life. Our data support elective repair of symptomatic PEH in the elderly, a population who may not always be referred for a surgical opinion.

Non-Elective Paraesophageal Hernia Repair Portends Worse Outcomes in Comparable Patients: a Propensity-Adjusted Analysis

“…The important consideration, however, is that understanding of patient comorbidities and frailty allows the patient and surgeon to weigh the level of operative risk against potential gains in quality of life in the elderly, as paraesophageal hernia repair has been shown to significantly improve quality of life and is associated with high rates of satisfaction. 26 Simply denying an elective operation to a symptomatic elderly person based on age is not supported by our analysis nor the analysis of others. 3,17,26 …”

“…26 Simply denying an elective operation to a symptomatic elderly person based on age is not supported by our analysis nor the analysis of others. 3,17,26 …”

Omission of the calibration bougie in laparoscopic repair of paraesophageal hernia

“…However, even in high-volume units, bougie-related esophageal and gastric perforation has been reported [5][6][7][8][9]. In the current series of otherwise identically repaired hiatal defects, bougie calibration of the hiatal closure and fundoplication were performed for the first 14 consecutive patients and omitted for the second 14 consecutive patients.…”

Morbidity and mortality associated with antireflux surgery with or without paraesophogeal hernia: a large ACS NSQIP analysis

“…Several studies have addressed the influence of age on PEH repair outcomes [2,[14][15][16]. In a study by Gangopadhyay et al [2], patients were stratified into three age groups (\65, 65-74, and C75 years) who underwent laparoscopic PEH repair.…”