Guan Lei, Nie Yusheng, Yuan Xin, Chen Jie, Yang Huiqi
Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2021 Apr;9(8):704. doi: 10.21037/atm-21-1495.
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.
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.
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% . 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, mesh-related 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.
Laparoscopic mesh repair of giant hiatal hernia for elderly patients is safe and effective when performed at experienced centers.
巨大食管裂孔疝在老年患者中更为常见，会显著降低他们的生活质量。然而，高龄患者的开放手术被认为与高发病率和死亡率相关。这项回顾性研究的目的是评估与年轻患者相比，老年患者腹腔镜巨大食管裂孔疝修补术的安全性。
2015年1月至2020年1月，152例连续患者接受了腹腔镜巨大食管裂孔疝修补术。排除2例失访病例。患者分为老年组（N = 62，年龄≥75岁）和年轻组（N = 88，年龄<75岁）。采用间断不可吸收缝线缝合脚，作为额外的加固，用可吸收钉或医用胶水固定补片。调查手术相关并发症、基于评分的症状变化趋势、胃肠道生活质量指数（GIQLI）、死亡率、复发率、血红蛋白以及质子泵抑制剂（PPI）的使用情况。
所有患者手术均顺利进行。老年组39例（62.9%）和年轻组44例（50.0%）采用了Dor胃底折叠术，无一例转为开放手术。虽然老年组美国麻醉医师协会（ASA）分级3级以及心血管和脑血管疾病的比例明显高于年轻组，但两组的手术时间、术中出血量和胸腔内胃的比例相似。老年组患者围手术期并发症往往较高，包括肺炎（3.2%）和肺不张（3.2%），但无统计学意义，与年轻患者相比，转入重症监护病房的比例也较高（9.7%对3.2%；P = 0.144）。年轻组术后平均住院时间（2.8天）也明显短于老年组（3.5天；P = 0.001）。两组随访期间均无死亡、复发、补片相关并发症，如内脏侵蚀、粘连或严重吞咽困难，两组的GIQLI评分和血红蛋白均有显著改善。两组中需要PPI的患者比例也有所降低。
在经验丰富的中心进行腹腔镜巨大食管裂孔疝修补术对老年患者是安全有效的。
