Laparoscopic anterior gastropexy for type III/IV hiatal hernia in elderly patients.
BACKGROUND
Large esophageal hiatal hernias occur most commonly in elderly patients with comorbidities, in whom even an elective surgery cannot be performed without high risks. Although fundoplication is recommended for esophageal hiatal hernia repair, we prefer not to limit our options to fundoplication, as obstruction is a frequent main complaint. We favor an anterior gastropexy approach instead to perform anti-reflux surgery and prevent recurrent protrusion and torsion of the incarcerated organ with minimal risk. The aim was to evaluate the safety and effectiveness of anterior gastropexy for large hiatal hernia in elderly patients with comorbidities.


METHODS
We retrospectively evaluated 8 patients who underwent laparoscopic anterior gastropexy for large hiatal hernia (type III or IV) since 2006. All patients were women with a median age of 82 years (range, 74-87 years). The major complaint was obstruction in all patients, with relatively mild reflux symptoms. They underwent successful laparoscopic surgery with no conversion to laparotomy. Fundoplication was performed in 4 cases. No perioperative complications occurred, and the main complaint resumed rapidly in all patients, without recurrence during postoperative follow-up of median 48 months (range, 5-77 months).


CONCLUSIONS
Laparoscopic anterior gastropexy is safe and effective and can be considered as one of the practical surgical options for large hiatal hernias in elderly patients, whom surgical intervention should be minimized due to their comorbidities.
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.|Division of Next Generation Endoscopic Intervention (Project ENGINE), Global Center for Advanced Medical Engineering and Informatics, Osaka University, Suite 0912, Center of Medical Innovation and Translational Research 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Shigeyoshi
S
Higashi
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. knakajima@gesurg.med.osaka-u.ac.jp.|Division of Next Generation Endoscopic Intervention (Project ENGINE), Global Center for Advanced Medical Engineering and Informatics, Osaka University, Suite 0912, Center of Medical Innovation and Translational Research 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. knakajima@gesurg.med.osaka-u.ac.jp.
Kiyokazu
K
Nakajima
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Koji
K
Tanaka
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Yasuhiro
Y
Miyazaki
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Tomoki
T
Makino
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Tsuyoshi
T
Takahashi
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Yukinori
Y
Kurokawa
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Makoto
M
Yamasaki
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Shuji
S
Takiguchi
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Masaki
M
Mori
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Yuichiro
Y
Doki
Anterior gastropexy; Elderly patients; Large esophageal hiatal hernia