A. D. Newton1, G. Savulionyte1, K. R. Dumon1, D. T. Dempsey1 1Hospital Of The University Of Pennsylvania,Surgery,Philadelphia, PA, USA
Introduction: We hypothesize that laparoscopic gastropexy is a good alternative to formal paraesophageal hernia repair in frail elderly patients with giant hernias and mechanical symptoms. There is a paucity of published data evaluating this.
Methods: We compared all 18 laparoscopic gastropexies done between August 1, 2011 and December 31, 2013 with 18 age and sex matched formal laparoscopic repairs (sac removal, closure of diaphragmatic defect, fundoplication +/- gastropexy) done over the same period by a single surgeon. Postoperative clinical outcomes, radiographic persistence or recurrence of hiatal hernia (UGI), quality of life (GIQOL index), and patient satisfaction were evaluated and compared.
Results: There was no significant difference in age between groups (gastropexy mean age: 79+/-10 years; formal repair mean age: 73+/-7 years). There were 14 females and 4 males in each group. All operations were completed laparoscopically. There were no hospital mortalities and one serious hospital complication (pneumonia requiring mechanical ventilation). (See table for other clinical outcomes and quality of life results.)
Results of radiographic evaluation of postoperative percentage of herniated stomach were as follows: (gastropexy: no hernia – 21%, 1-9% herniated – 0%, 10-19% herniated – 7%, 20-29% herniated – 50%, >29% herniated – 21%; formal repair: no hernia – 56%, 1-9% herniated – 31%, 10-19% herniated – 13%, 20-29% herniated – 0%, > 29% herniated – 0%, p < 0.01).
Conclusion: Laparoscopic gastropexy is a safe and useful operation in elderly patients with large paraesophageal hiatal hernias. It is well tolerated and patient satisfaction is high. Residual or recurrent hiatal hernia is very common after gastropexy, and also common after formal repair, but does not correlate with postoperative patient satisfaction and symptoms in either group.
