Laparoscopic repair of giant hiatal hernia for elderly patients

Abstract

Background: Giant hiatal hernias are more common in older patients and can significantly reduce their quality of life. However, open surgery for patients of advanced age is thought to be associated with high morbidity and mortality. The aim of this retrospective study was to evaluate the safety of laparoscopic giant hiatal hernia repair for elderly patients as compared to younger patients.Methods: From January 2015 to January 2020, 152 consecutive patients underwent laparoscopic mesh repair of giant hiatal hernia. Two cases of missing follow up were excluded. Patients were divided into an elderly group (N=62, age ≥75) and a younger group (N=88, age <75). Interrupted non-absorbable suture was applied for crus closure and as an additional reinforcement, the mesh was fixed with absorbable tacks or medical glue. Procedure-related complications, score-based variation tendency of symptoms, gastrointestinal quality of life index (GIQLI), mortality, recurrence rate, hemoglobin, and the use of PPI were investigated.Results: All patients underwent the procedure uneventfully. Dor fundoplication was used in 39 patients (62.9%) in the elderly group and 44 (50.0%) in the younger group and no case was converted to open.While the elderly group had a significantly higher percentage of ASA Class level 3 and cardiovascular and cerebrovascular diseases as compared to the younger group, the two groups had similar operative times, intraoperative blood loss, and percentage of intrathoracic stomach. Elderly group patients tended to have higher perioperative complications including pneumonia (3.2%) and atelectasis (3.2%) without statistical significance, as well as transfer to the intensive care unit compared, to younger patients (9.7% vs. 3.2%; P=0.144). The mean post-operative hospital stay was also significantly shorter in the younger group (2.8 days) compared with the elderly group (3.5 days; P=0.001). There was no mortality, recurrence, meshrelated complications such as visceral erosion, adhesion, or severe dysphagia during follow up in the two groups, and both groups demonstrated significant improvement in GIQLI scores and hemoglobin. The percentage of patients who needed PPI was also reduced in both groups.Conclusions: Laparoscopic mesh repair of giant hiatal hernia for elderly patients is safe and effective when performed at experienced centers.

Laparoscopic proximal sleeve gastrectomy as an alternative for management of giant hiatal hernias

“…It may have a primary or secondary shortened esophagus, but today most surgeons doubt its real existence, therefore treatment of HH associated with a short esophagus is still a matter of controversy. [6][7][8][9] The symptoms are usually chronic, associated with GERD, heartburn, chest pain, lack of gastric emptying, early satiety, and dysphagia as one of the most common complaints, but in the case of gastric volvulus, they may have an acute and life-threatening condition if ischemia or necrosis develop as the fourth case presented here. Therefore, surgical repair is recommended, but recurrence is very high as reported with a wide range between 12 to 65%.…”

Is it meaningful to add mesh reinforcement to laparoscopic fundoplication for esophageal hiatal hernias?

“…Surgical technique problems aside, increased abdominal pressure is an important cause of recurrence of esophageal hiatal hernia, speci cally obesity and gibbus [8,9,24]. Furthermore, the tissues of the esophageal hiatus, including the crus of the diaphragm, are often fragile in the elderly, with being old itself considered a risk factor for postoperative recurrence [10].…”

Stomach versus heart: case report of a giant hiatal hernia with perforated gastric ulcer with obstructive shock

“…A number of studies have reported acute complications of giant hiatal hernia, such as acute gastric volvulus, intrathoracic gastric perforation, and incarcerated obstruction of the herniated viscera. 2 The presentation of symptoms is usually nonspecific and in most cases the diagnosis results from an imaging study finding.…”