Age-related outcomes in laparoscopic hiatal hernia repair: Is there a “too old” for antireflux surgery?

Addo, Alex; Sanford, Zachary; Broda, Andrew; Zahiri, H. Reza; Park, Adrian

doi:10.1007/s00464-020-07489-5

Cited by 11 publications

(3 citation statements)

References 30 publications

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“…In our study, there was no statistically significant association between the demographic factors and the outcome after laparoscopic Nissen fundoplication. This is in line with Ip et al [10] who confirmed that the demographic factors don't predict the laparoscopic Nissen fundoplication outcomes, and also agree with Addo et al [11] who reported that postoperative outcomes and complication rates were parallel among all age groups and the age of patients is not a predictor of the outcomes after Nissen fundoplication. However, these results disagree with Cowgill et al [12] who concluded that Safe laparoscopic fundoplication improves GERD symptoms in the elderly, with outcomes similar to or better than those found in younger patients.…”

Section: Discussionsupporting

confidence: 86%

Predictors of Outcome after Laparoscopic Nissen Fundoplication

El-Atiar,

Almaadawy,

Naroz

et al. 2023

International Journal of Medical Arts

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Article informationBackground: Laparoscopic Nissen fundoplication with posterior hiatal repair is now thought to be the best way to treat severe Gastroesophageal Reflux Disease with surgery [GERD]. Long-term studies have shown that it gives most patients good control of their reflux symptoms and good clinical outcomes. Aim of the work:This study aims to identify the predictive factors of the surgical outcomes of laparoscopic Nissen fundoplication.

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Section: Discussionsupporting

confidence: 86%

Predictors of Outcome after Laparoscopic Nissen Fundoplication

El-Atiar,

Almaadawy,

Naroz

et al. 2023

International Journal of Medical Arts

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“…Currently, the high discrepancy among published results regarding LPEHR in the aged population contributes to the ongoing debate. Some authors advocate surgical repair because of comparable complication rates between old and young patients, as well as long-term quality of life (QoL) improvements [10,11,3]. However, higher operative times, intraoperative complications, lengths of hospital stay, reoperation, and mortality rates reported by other authors suggested that elderly patients could well benefit from the watchful wait strategy [9,12].…”

Section: Discussionmentioning

confidence: 99%

Impact of surgical repair on type IV paraesophageal hernias (PEHs)

et al. 2021

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Background Paraesophageal hernias (PEHs; types II-III-IV) account for about 5% of all hiatal hernias (HHs). The peculiarity of PEHs is the presence of a herniated sac which contains a more or less important part of the stomach, along with other abdominal organs in type IV PEHs. Surgical treatment is more complex since it requires a reduction not only of the herniated content but also of the "container," namely the sac adherent to mediastinal structures. Since type III and IV PEHs are mostly grouped together as large PEHs, there is a lack of articles in the literature with regards to clear surgical outcomes, as well as management algorithms in type IV PEHs. This study aims to compare outcomes in type IV vs. type III PEHs after surgical repair. Methods A retrospective study of patients who underwent laparoscopic PEH hernia repair (LPEHR) was conducted in a single institution between 2006 and 2020. Patient baseline characteristics and surgical outcomes were analyzed. Results A total of 103 patients were included in the analysis. Patients presenting with type IV PEHs (12/103) were significantly older than patients with type III PEHs (91/104) (75.25 ± 7.15 vs. 66.91 ± 13.58 respectively (p = 0.039), and more fragile with a higher Charlson Comorbidity Index (CCI) (4.25 ± 1.48 vs. 2.96 ± 1.72, p = 0.016). Operative time was significantly longer (243 ± 101.73 vs. 133.38 ± 61.76, p = 0.002), and postoperative morbidity was significantly higher in type IV PEH repair (50% vs. 8.8% type III, p = 0.000). Conclusion Patients with type IV PEHs appear to be older and frailer. The higher incidence of postoperative complications in patients with type IV PEHs should advocate for a precise indication for surgical treatment, which should be performed in centers of expertise.

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“…ARS in patients aged >65 years has been reported to be safe in some studies, whereas others have reported a high rate of intraoperative complications and postoperative mortality [ 41 , 42 , 43 , 44 ]. In particular, patients aged >75 years had a higher risk of intraoperative complications (odds ratio (OR) 2.94, p = 0.003)) and reoperations (OR 2.36, p < 0.05), along with longer operation times (ß 6.29, p < 0.001) and lengths of hospital stay (ß 0.56, p < 0.001) [ 45 ]. Patients < 65 years have more typical symptoms and less esophageal dysmotility than those aged 65 years or older [ 46 ].…”

Section: Patient Selection Of Arsmentioning

confidence: 99%

Current Status of Anti-Reflux Surgery as a Treatment for GERD

Lee,

et al. 2024

Medicina

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Anti-reflux surgery (ARS) is an efficient treatment option for gastroesophageal reflux disease (GERD). Despite growing evidence of the efficacy and safety of ARS, medications including proton pump inhibitors (PPIs) remain the most commonly administered treatments for GERD. Meanwhile, ARS can be an effective treatment option for patients who need medications continuously or for those who are refractory to PPI treatment, if proper candidates are selected. However, in practice, ARS is often regarded as a last resort for patients who are unresponsive to PPIs. Accumulating ARS-related studies indicate that surgery is equivalent to or better than medical treatment for controlling typical and atypical GERD symptoms. Furthermore, because of overall reduced medication expenses, ARS may be more cost-effective than PPI. Patients are selected for ARS based on endoscopic findings, esophageal acid exposure time, and PPI responsiveness. Although there is limited evidence, ARS may be expanded to include patients with normal acid exposure, such as those with reflux hypersensitivity. Additionally, other factors such as age, body mass index, and comorbidities are known to affect ARS outcomes; and such factors should be considered. Nissen fundoplication or partial fundoplication including Dor fundoplication and Toupet fundoplication can be chosen, depending on whether the patient prioritizes symptom improvement or minimizing postoperative symptoms such as dysphagia. Furthermore, efforts to reduce and manage postoperative complications and create awareness of the long-term efficacy and safety of the ARS are recommended, as well as adequate training programs for new surgeons.

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Age-related outcomes in laparoscopic hiatal hernia repair: Is there a “too old” for antireflux surgery?

Cited by 11 publications

References 30 publications

Predictors of Outcome after Laparoscopic Nissen Fundoplication

Predictors of Outcome after Laparoscopic Nissen Fundoplication

Impact of surgical repair on type IV paraesophageal hernias (PEHs)

Current Status of Anti-Reflux Surgery as a Treatment for GERD

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