Abstract:
Background:
Very large hiatus hernias are often symptomatic, impact quality of life, and are increasingly encountered in aging populations. Laparoscopic repair offers excellent clinical outcomes. However, surgeons may be reluctant to offer repair to the elderly due to concerns about morbidity and mortality. To determine safety, we evaluated outcomes following repair of very large hiatus hernias in patients aged 80 years and older compared to younger patients.
Methods:
Data was extracted from a prospective database. Patients who underwent repair of a very large hiatus hernia (> 50% intrathoracic stomach) were included and categorised: young (< 70 years), elderly (70 – 79 years), octogenarian (> 80 years).
Results:
1353 patients underwent surgery (< 70 years: 733 [54.2%], 70 – 79 years: 451 [33.3%], > 80 years: 169 [12.5%]). Young and elderly patients were more likely to undergo elective surgery for heartburn (56.6% vs 44.4% vs 29.0%, p < 0.001), whereas octogenarians underwent emergency surgery for volvulus (5.4% vs 6.6% vs 14.5%, p = 0.019). Conversion to open (0.8% vs 0.9% vs 5.0%, p = 0.002) and length of stay (2.69 vs 3.19 vs 4.62 days, p < 0.001) were greater in octogenarian group. Major complications (4.2% vs 5.1% vs 8.1%, p = 0.120) were similar. Mortality rates were low for all groups but highest in octogenarians (0.3% vs 0.4% vs 1.8%, p = 0.048).
Conclusion:
Major complications and overall mortality rates remain low in octogenarians. Surgical repair should not be withheld for patients over 80 who are otherwise fit.