Michael J Furey, Sundarachalam Pindicura, Nick Cassata, Jordan Salvato, Jason Salvato, Alexandra Falvo, Mark E Mahan, Vladan Obradovic, Osama Shaheen, David Parker, Anthony Petrick, Ryan D Horsley
Operative repair of PEH in the elderly remains safe and effective with better outcomes when done electively. To our knowledge, this is the largest study to evaluate LPEHR outcomes in nonagenarians. Referral to foregut surgeons should be considered regardless of age, at the time of identification of a symptomatic PEH, as elective repair shows the best outcomes.
INTRODUCTION: The majority of paraesophageal hernias (PEH) present in patients > 65 years old. We have previously reported the safety of laparoscopic paraesophageal hernia repair (LPEHR) in these patients. However, information regarding outcomes of LPEHR in nonagenarians is scant. Surgical mortality in nonagenarians has been reported as high as 20%. Many referring providers are reluctant to refer elderly patients for LPEHR because they believe the surgical risk is prohibitive. We designed this study to evaluate LPEHR outcomes at our institution in nonagenarians, elective vs non-elective.
METHODS: A single-institution retrospective cohort study of patients who underwent LPEHR January 1, 2003, to July 1, 2025, was performed in patients ≥ 90 years old at the time of surgery. Descriptive statistics and univariate analysis were performed to analyze the differences in patients undergoing elective vs non-elective repair. Non-elective repair was defined as presentation to the emergency department and/or transfer from outside institution with repair during that same hospitalization.
RESULTS: A total of 34 patients age ≥90 (mean 92.32), predominantly female (70.59%), underwent LPEHR; 10 undergoing elective repair and 24 undergoing non-elective repair. Non-elective cases resulted in more ICU admissions (11, 45.83% vs 1, 10.0%), higher 30-day mortality (4, 16.67% vs 1, 10%), significantly longer length of stay (6.88 days vs 4.50 days, p = 0.03), and higher complication rates (12, 50.0% vs 1, 10.0%). Reoperations were similar. There was no significant difference between elective and non-elective patient discharge back to home after LPEHR (5, 50.0% vs 13, 54.17%).
CONCLUSION: Operative repair of PEH in the elderly remains safe and effective with better outcomes when done electively. To our knowledge, this is the largest study to evaluate LPEHR outcomes in nonagenarians. Referral to foregut surgeons should be considered regardless of age, at the time of identification of a symptomatic PEH, as elective repair shows the best outcomes.