Observational medical treatment or surgery for giant paraesophageal hiatal hernia in elderly patients

Abstract Giant paraesophageal hernias (GPHH) occur frequently in the elderly and account for about 5–10% of all hiatal hernias. Up to now controversy persists between expected medical treatment and surgical treatment. To assess if an indication for surgical repair of GPHH is possible in elderly pati...

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Bibliographic Details
Published in:Diseases of the esophagus 2022-12, Vol.35 (12)
Main Authors: Braghetto, Italo, Molina, Juan Carlos, Korn, Owen, Lanzarini, Enrique, Musleh, Maher, Figueroa, Manuel, Rojas, Jorge
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Fundoplication - adverse effects
Hernia, Hiatal - surgery
Herniorrhaphy
Humans
Laparoscopy
Prospective Studies
Treatment Outcome
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Summary:Abstract Giant paraesophageal hernias (GPHH) occur frequently in the elderly and account for about 5–10% of all hiatal hernias. Up to now controversy persists between expected medical treatment and surgical treatment. To assess if an indication for surgical repair of GPHH is possible in elderly patients. A prospective study that includes patients over 70 years of age hospitalized from January 2015 to December 2019 with GPHH. Patients were separated into Group A and Group B. Group A consisted of a cohort of 23 patients in whom observation and medical treatment were performed. Group B consisted of 44 patients submitted to elective laparoscopic hiatal hernia repair. Symptomatic patients were observed in both groups (20/23 in Group A and 38/44 in Group B). Charlson’s score >6 and ASA II or III were more frequent in Group A. Patients in Group A presented symptoms many years before their hospitalization in comparison to Group B (21.8+7.8 vs. 6.2+3.5 years, respectively) (P=0.0001). Emergency hospitalization was observed exclusively in Group A. Acute complications were frequently observed and hospital stays were significantly longer in Group A, 14 patients were subjected to medical management and 6 to emergency surgery. In-hospital mortality occurred in 13/20 patients (65%) versus 1/38 patients (2.6%) in Group B (P=0.0001). Laparoscopic paraesophageal hiatal hernia repair can be done safely, effectively, and in a timely manner in elderly patients at specialized surgical teams. Advanced age alone should not be a limiting factor for the repair of paraesophageal hernias.
ISSN:1120-8694
1442-2050
DOI:10.1093/dote/doac030