Wahi Jessica E, Alsayegh Fadi, Kalathoor Jacob, Safdie Fernando M
Department of Thoracic and Cardiovascular Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA.
Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA.
J Laparoendosc Adv Surg Tech A. 2025 Jul;35(7):538-541. doi: 10.1089/lap.2025.0017. Epub 2025 Jun 4.
The aging population has led to an increase in the prevalence of symptomatic paraesophageal hernias (PEHs), particularly among octogenarians. While elective repair is associated with improved outcomes compared to emergency repair, there are limited data on the safety and efficacy of robotic-assisted PEH repair in this high-risk population. We conducted a retrospective review of patients aged 65-89 who underwent robotic-assisted elective type IV PEH repair by a single surgeon at Mount Sinai Medical Center from 2020 to 2023. Patients were divided into two cohorts: octogenarians (80-89 years) and seniors (65-79 years). Demographics, perioperative outcomes, and complications were analyzed. A total of 38 patients were included, with 15 octogenarians and 23 seniors. The mean ages were 84 ± 2 years and 73 ± 5 years, respectively. The majority of patients were female (73% octogenarians, 87% seniors), and the average body mass index was comparable between cohorts (25 kg/m ± 3.7 versus 25 ± 4.7). The mean hospital length of stay was 2.7 ± 1.8 days for octogenarians and 2.4 ± 1.8 days for seniors ( = .6). No intraoperative complications or 30-day mortality occurred. Two octogenarians (13%) and three seniors (13%) were readmitted within 30 days. At 6 months, 87% of octogenarians and 69% of seniors reported resolution of preoperative symptoms ( = .3). Robotic-assisted repair of type IV PEHs is a safe and effective option for both octogenarians and seniors. The absence of intraoperative complications and 30-day mortality supports its feasibility in elderly patients, including those in their eighth decade of life. These findings advocate for elective minimally invasive repair in carefully selected patients, regardless of advanced age, and highlight the importance of further studies to validate long-term outcomes.
人口老龄化导致有症状的食管旁疝（PEH）患病率增加，尤其是在八旬老人中。虽然择期修复与急诊修复相比，预后有所改善，但关于机器人辅助PEH修复在这一高风险人群中的安全性和有效性的数据有限。我们对2020年至2023年在西奈山医疗中心由一名外科医生进行机器人辅助择期IV型PEH修复的65至89岁患者进行了回顾性研究。患者分为两个队列：八旬老人（80 - 89岁）和老年人（65 - 79岁）。分析了人口统计学、围手术期结果和并发症。共纳入38例患者，其中15例八旬老人和23例老年人。平均年龄分别为84±2岁和73±5岁。大多数患者为女性（八旬老人中占73%，老年人中占87%），队列间平均体重指数相当（25 kg/m²±3.7对25±4.7）。八旬老人的平均住院时间为2.7±1.8天，老年人为2.4±1.8天（P = 0.6）。未发生术中并发症或30天死亡率。两名八旬老人（13%）和三名老年人（13%）在30天内再次入院。在6个月时，87%的八旬老人和69%的老年人报告术前症状消失（P = 0.3）。机器人辅助IV型PEH修复对于八旬老人和老年人都是一种安全有效的选择。术中无并发症和30天死亡率支持了其在老年患者（包括80多岁的患者）中的可行性。这些发现提倡在精心挑选的患者中进行择期微创修复，无论年龄多大，并强调进一步研究以验证长期结果的重要性。
