Anahita D Jalilvand, MD1, Edward L Jones, MD2, Sara E Martin del Campo, MD, MS1, Kyle A Perry, MD1. 1The Ohio State Wexner Medical Center, 2UC Denver
INTRODUCTION: Traditionally, surgical repair has been recommended for patients with symptomatic paraesophageal hernia (PEH). While laparoscopic PEH repair (LPEHR) is safe and effective, controversy remains as to whether all populations benefit equally from elective repair, particularly the elderly. The objective of this study was to assess outcomes of LPEHR in octogenarians compared to younger patients.
METHODS: We performed a review of all patients undergoing LPEHR between 2011 and 2016. The presence of a PEH was confirmed by endoscopy, barium esophagram, or computed tomography. OR time, length of stay (LOS), and complication rate were obtained through chart review. Disease specific quality of life was assessed using the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaire. Baseline and post-operative data were collected in the clinic setting. Data are maintained in an IRB approved database, and presented as incidence (%), mean ± SD, or median (IQ range) as appropriate. A p-value of <0.05 was considered statistically significant.
RESULTS: 207 patients underwent LPEHR during the study period. 177 patients were under 80 years of age, with an average of 63 ± 12.2 years, and 30 were older than 80 years old, with an average age of 85.1 ± 3.0 years. In the octogenarian group, 76.7% were female compared to 74% of patients under 80 (p=0.825). Octogenarians had a lower mean BMI (25.9 ± 6.1 vs. 31.1 ± 6.1, p<0.001), and 86.7% had an ASA classification of 3 or 4 compared to 68% of younger patients (p=0.05) The most common presenting symptoms in octogenarians were chest pain (57%) and early satiety (20%) and reflux symptoms (46%) and chest pain (33%) in younger patients (p=0.01). Operative time (108 ± 35 min versus 108 ± 32min, p=0.94), estimated blood loss (p=0.25), and complication rate (27% versus 14%, p=0.10) were not statistically different between groups. Median LOS was 3 (2-33) days for octogenarians compared to 2 (1-37) days for younger patients (p<0.01). GERD-HRQL scores improved from 14 (1-33) to 2 (1-29, p=0.172) in octogenarians and 20 (0-50) to 3 (0-38, p<0.01) in younger patients.
CONCLUSION: LPEHR can be safely performed in octogenarians with improved disease specific quality of life in many patients; however, LPEHR is associated with longer hospital LOS and increased risk of complications compared to younger patients. Careful consideration should be given to a patient’s symptoms and their impact on quality of life when weighing the risks and benefits of LPEHR in this patient population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80274
Program Number: P368
Presentation Session: Poster (Non CME)
Presentation Type: Poster
