Straatman J, Groen L C B, van der Wielen N, Jansma E P, Daams F, Cuesta M A, van der Peet D L
Department of Gastrointestinal Surgery.
Medical library, VU University Medical Center, Amsterdam, The Netherlands.
Dis Esophagus. 2018 Jul 1;31(7). doi: 10.1093/dote/doy010.
Over the coming years octogenarians will make up an increasingly large proportion of the population. With the rise in octogenarians more paraesophageal hiatal hernias may be identified. In research for the optimal treatment for paraesophageal hiatal hernias, octogenarians are often omitted and the optimal surgical strategy for this patient group remains unclear. A systematic search in PubMed, Embase, and The Cochrane Library was conducted, including articles compromising 'surgery,' 'paraesophageal hiatal hernia,' and 'octogenarians.' Selection of articles was based on independent review by two authors. Alongside, a retrospective cohort study was conducted including all type II-IV hiatal hernia repairs performed in the VU Medical Center in Amsterdam, The Netherlands, from 2005 to 2015. A total of 486 papers were eligible for selection. After careful selection, a total of eight articles were included. All articles were retrospective cohort studies describing different proportions of octogenarians. The populations and surgical techniques were very heterogeneous. Elective paraesophageal hiatal hernia repair was performed safely in symptomatic octogenarians in all studies. Additional analysis of 84 patients, of which 9.5% octogenarians, was performed at our tertiary referral center. A larger hernia type, more acute interventions and a higher morbidity and mortality rate was observed in octogenarians compared to patients aged <80 years. In conclusion, elective paraesophageal hiatal hernia repair can be performed in octogenarians, especially in patients without comorbidity. Findings suggest improvement in symptoms in short-term follow up, with minimal morbidity and mortality. With regard to surgical techniques, laparoscopy and fundoplication were performed safely. Octogenarians need to be included in future clinical trials to further evaluate the optimal surgical intervention. Preoperative risk assessment by clinical prediction rules should guide operative intervention, in order to evaluate risks and benefits in this challenging population.
在未来几年里，八旬老人在人口中所占的比例将越来越大。随着八旬老人数量的增加，可能会发现更多的食管旁裂孔疝。在研究食管旁裂孔疝的最佳治疗方法时，八旬老人常常被排除在外，而这一患者群体的最佳手术策略仍不明确。我们在PubMed、Embase和Cochrane图书馆进行了系统检索，检索词包括“手术”、“食管旁裂孔疝”和“八旬老人”。文章的筛选由两位作者独立进行。此外，我们进行了一项回顾性队列研究，纳入了2005年至2015年在荷兰阿姆斯特丹VU医学中心进行的所有II-IV型裂孔疝修补术。共有486篇论文符合入选标准。经过仔细筛选，共纳入了8篇文章。所有文章均为回顾性队列研究，描述了不同比例的八旬老人。研究人群和手术技术差异很大。在所有研究中，有症状的八旬老人均安全地接受了择期食管旁裂孔疝修补术。我们的三级转诊中心对84例患者进行了进一步分析，其中八旬老人占9.5%。与80岁以下的患者相比，八旬老人的疝类型更大，急诊手术更多，发病率和死亡率更高。总之，择期食管旁裂孔疝修补术可以在八旬老人中进行，尤其是在没有合并症的患者中。研究结果表明，短期随访中症状有所改善，发病率和死亡率极低。关于手术技术，腹腔镜手术和胃底折叠术的实施是安全的。未来的临床试验应纳入八旬老人，以进一步评估最佳手术干预措施。临床预测规则进行的术前风险评估应指导手术干预，以便在这一具有挑战性的人群中评估风险和益处。
