Repair of symptomatic giant paraesophageal hernias in elderly (>70 years) patients results in improved quality of life.
BACKGROUND
Giant paraesophageal hernias (PEH) involve herniation ofstomach and/or other viscera into the mediastinum. These are usually symptomatic and commonly occur in the elderly. The benefits and risks of operating on elderly patients with giant PEH have not been clearly elucidated.


METHODS
We performed a retrospective chart review of consecutive patients aged 70 or greater with giant PEHs undergoing repair.Quality of life data were gathered using QOLRAD, GERD-HRQL and adysphagia severity score.


RESULTS
Fifty-eight patients (34 females), median 78 years old, presented for repair. Nine patients presented urgently. There was no 30-day mortality. Major morbidity was 15.5%. At mean follow-up of 1.3 years, 81% were symptom free compared to baseline (p < 0.0001). Both short-term (p < 0.001) and long term QOLRAD (p < 0.001) scores improved significantly, as did GERD HRQL scores (p < 0.001). Dysphagia scores worsened in the short term but returned to baseline at long term follow up.


CONCLUSIONS
Symptomatic giant PEH in this elderly population can be repaired with symptomatic improvement, minimal morbidity and mortality in both the elective and urgent setting. The decision to operate should be made by a physician experienced in managing this complex patient population.
Division of Thoracic and Foregut Surgery, Swedish Cancer Institute and Medical Center, Suite 850, 1101 Madison Street, Seattle, WA 98105, USA. brian.louie@swedish.org
Brian E
BE
Louie
Maurice
M
Blitz
Alexander S
AS
Farivar
Jeraldine
J
Orlina
Ralph W
RW
Aye
D000368:Aged; D000369:Aged, 80 and over; D004415:Dyspepsia / Q000523:psychology; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000523:psychology; D006551:Hernia, Hiatal / Q000523:psychology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D011183:Postoperative Complications; D011788:Quality of Life / Q000523:psychology*; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Ann Thorac Surg. 2008 Jun;85(6):1947-52
18498800
J Thorac Cardiovasc Surg. 2010 Feb;139(2):395-404, 404.e1
20004917
JSLS. 2007 Jul-Sep;11(3):344-9
17931517
Ann Surg. 2002 Oct;236(4):492-500; discussion 500-1
12368678
Ann Surg. 2006 Oct;244(4):481-90
16998356
Thorac Surg Clin. 2009 Nov;19(4):473-84
20112630
Dis Esophagus. 2008;21(1):63-8
18197941
J Gastrointest Surg. 2002 Mar-Apr;6(2):181-8; discussion 188
11992803
J Thorac Cardiovasc Surg. 1998 Jan;115(1):53-60; discussion 61-2
9451045
Surg Endosc. 2003 Apr;17(4):551-3
12582773
J Gastrointest Surg. 2008 Dec;12(12):2066-75; discussion 2075-7
18841422
Eur J Surg Suppl. 1998;(583):41-9
10027672
J Gastrointest Surg. 2010 Feb;14(2):203-10
19957207
Dis Esophagus. 2007;20(2):130-4
17439596
J Clin Gastroenterol. 1992 Mar;14(2):99-100
1556441
Dis Esophagus. 2008;21(8):737-41
18459987