1
|
Hage K, Cornejo J, Allotey JK, Castillo-Larios R, Caposole MZ, Iskandar M, Kellogg TA, Galvani C, Elli EF, Ghanem OM. Feasibility and Outcomes of Simultaneous Gastric Bypass with Paraesophageal Hernia Repair in Elderly Patients. Obes Surg 2023; 33:2734-2741. [PMID: 37454304 DOI: 10.1007/s11695-023-06726-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Paraesophageal hernias (PEH) have a higher incidence in patients with obesity. Roux-en-Y gastric bypass (RYGB) with concomitant PEH repair is established as a valid surgical option for PEH management in patients with obesity. The safety and feasibility of this approach in the elderly population are not well elucidated. METHODS We performed a multicenter retrospective cohort study of patients aged 65 years and older who underwent simultaneous PEH repair and RYGB from 2008 to 2022. Patient demographics, hernia characteristics, postoperative complications, and weight loss data were collected. Obesity-related medical conditions' resolution rates were evaluated at the last follow-up. A matched paired t-test and Pearson's test were used to assess continuous and categorical parameters, respectively. RESULTS A total of 40 patients (82.5% female; age, 69.2 ± 3.6 years; BMI, 39.4 ± 4.7 kg/m2) with a mean follow-up of 32.3 months were included. The average hernia size was 5.8 cm. Most cases did not require mesh use during surgery (92.5%) with only 3 (7.5%) hernial recurrences. Postoperative complications (17.5%) and mortality rates (2.5%), as well as readmission (2.5%), reoperation (2.5%), and reintervention (0%) rates at 30-day follow-up were reported. There was a statistically significant resolution in gastroesophageal reflux disease (p < 0.001), hypertension (p = 0.019), and sleep apnea (p = 0.014). CONCLUSIONS The safety and effectiveness of simultaneous PEH repair and RYGB are adequate for the elderly population. Patient selection is crucial to reduce postoperative complications. Further studies with larger cohorts are needed to fully assess the impact of this surgery on elderly patients with obesity.
Collapse
Affiliation(s)
- Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jorge Cornejo
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Jonathan K Allotey
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Rocio Castillo-Larios
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Michael Z Caposole
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Mazen Iskandar
- Department of Surgery, Baylor Scott and White Medical Center, Waxahachie, TX, 75165, USA
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carlos Galvani
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Enrique F Elli
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
| |
Collapse
|
2
|
Khoma O, Wong NLJ, Mugino M, Khoma MJ, Van der Wall H, Falk GL. Dyspnoea improves following composite repair of giant paraoesophageal hernia. Ann R Coll Surg Engl 2023; 105:523-527. [PMID: 36374275 PMCID: PMC10313459 DOI: 10.1308/rcsann.2022.0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Paraoesophageal hernias (PEH) are often symptomatic and can lead to life-threatening complications such as volvulus and ischaemia. Dyspnoea is one of the most prevalent symptoms of giant hiatus herniae. The primary outcome of this study is resolution of dyspnoea following composite repair of giant paraoesophageal hernia. Secondary outcomes include complications of surgery, hernia recurrence rates and effect of recurrence on dyspnoea. METHODS Data were extracted from a prospectively maintained single-surgeon database containing records of all patients undergoing composite repair of paraoesophageal hernia. Patients presenting with dyspnoea who underwent composite laparoscopic repair of giant (>30% of stomach above diaphragm) paraoesophageal hernia between March 2009 and December 2015 were included. RESULTS Inclusion criteria were met by 154 patients. The mean age at time of surgery was 71.2 years (range 49-93, SD 9.66) with an average BMI of 28 (range 19-38kg/m2, SD 4.1). On average hernia contained 64% of stomach (range 30-100%, SD 20.2). One procedure was converted to laparotomy. Surgery resulted in near complete resolution of dyspnoea (2.6% postoperatively, p<0.001). Recurrence rate was 24% and was not associated with persistent dyspnoea. There was one death and two significant complications. CONCLUSION Dyspnoea resolves following laparoscopic repair of giant paraoesophageal hernia. The presence of dyspnoea in patients with known large paraoesophageal hernia should be regarded as an indication for referral to a surgical service with expertise in hiatal hernia management.
Collapse
Affiliation(s)
- O Khoma
- University of Notre Dame, Chippendale, New South Wales, Australia
| | - NLJ Wong
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - M Mugino
- University of Notre Dame, Chippendale, New South Wales, Australia
| | - MJ Khoma
- Sydney Heartburn Clinic, Australia
| | - H Van der Wall
- University of Notre Dame, Chippendale, New South Wales, Australia
| | - GL Falk
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| |
Collapse
|
3
|
Hoshino M, Omura N, Yano F, Tsuboi K, Yamamoto SR, Akimoto S, Masuda T, Sakashita Y, Fukushima N, Kashiwagi H. Therapeutic effect of laparoscopic fundoplication for GERD-related disease in the elderly. Gen Thorac Cardiovasc Surg 2021; 70:72-78. [PMID: 34561760 DOI: 10.1007/s11748-021-01713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is anticipated that surgical treatment for gastro-esophageal reflux disease (GERD) in the elderly will increase. This time, using propensity score matching, we examined the results of laparoscopic fundoplication (LF) for GERD-related diseases in the elderly. METHODS Of 302 cases which underwent initial LF for GERD-related diseases during the period from June 2008 to February 2019, we classified them into elderly (65 years of age or older) and non-elderly groups (64 years of age or younger). 57 cases each were extracted upon performing propensity score matching regarding five factors including: gender; body mass index; esophageal hiatal hernia; extent of reflux esophagitis; and the use of mesh. RESULTS With regard to the preoperative disease status, the pH < 4 holding time was indicated as 2.8% (0.5-10.7%) in the elderly group and 3.4% (0.6-8.0%) in the non-elderly group, with no difference in terms of the illness period as well (p = 0.889 and p = 0.263, respectively). Although there was no difference in terms of the operative time (155 vs. 139 min, p = 0.092) and estimated blood loss (both ≒ 0 ml, p = 0.298), postoperative hospital stay was prolonged in the elderly group [7 (7-9) vs. 7 (7-7), p = 0.007]. On the other hand, esophageal hiatal hernia, reflux esophagitis, and acid reflux time in the esophagus were all improved following surgery in both groups (p < 0.001 in both groups). CONCLUSION The treatment results of LF for GERD-related diseases in the elderly were as good as those in the non-elderly, indicating possible safe implementation.
Collapse
Affiliation(s)
- Masato Hoshino
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Nobuo Omura
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
- Department of Surgery, National Hospital Organization, Nishisaitama-Chuo National Hospital, Saitama, Japan
| | - Fumiaki Yano
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazuto Tsuboi
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Se Ryung Yamamoto
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shunsuke Akimoto
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takahiro Masuda
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuki Sakashita
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Naoko Fukushima
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hideyuki Kashiwagi
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| |
Collapse
|
4
|
Guan L, Nie Y, Yuan X, Chen J, Yang H. Laparoscopic repair of giant hiatal hernia for elderly patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:704. [PMID: 33987402 PMCID: PMC8106099 DOI: 10.21037/atm-21-1495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Giant hiatal hernias are more common in older patients and can significantly reduce their quality of life. However, open surgery for patients of advanced age is thought to be associated with high morbidity and mortality. The aim of this retrospective study was to evaluate the safety of laparoscopic giant hiatal hernia repair for elderly patients as compared to younger patients. Methods From January 2015 to January 2020, 152 consecutive patients underwent laparoscopic mesh repair of giant hiatal hernia. Two cases of missing follow up were excluded. Patients were divided into an elderly group (N=62, age ≥75) and a younger group (N=88, age <75). Interrupted non-absorbable suture was applied for crus closure and as an additional reinforcement, the mesh was fixed with absorbable tacks or medical glue. Procedure-related complications, score-based variation tendency of symptoms, gastrointestinal quality of life index (GIQLI), mortality, recurrence rate, hemoglobin, and the use of PPI were investigated. Results All patients underwent the procedure uneventfully. Dor fundoplication was used in 39 patients (62.9%) in the elderly group and 44 (50.0%) in the younger group and no case was converted to open. While the elderly group had a significantly higher percentage of ASA Class level 3 and cardiovascular and cerebrovascular diseases as compared to the younger group, the two groups had similar operative times, intraoperative blood loss, and percentage of intrathoracic stomach. Elderly group patients tended to have higher perioperative complications including pneumonia (3.2%) and atelectasis (3.2%) without statistical significance, as well as transfer to the intensive care unit compared, to younger patients (9.7% vs. 3.2%; P=0.144). The mean post-operative hospital stay was also significantly shorter in the younger group (2.8 days) compared with the elderly group (3.5 days; P=0.001). There was no mortality, recurrence, mesh-related complications such as visceral erosion, adhesion, or severe dysphagia during follow up in the two groups, and both groups demonstrated significant improvement in GIQLI scores and hemoglobin. The percentage of patients who needed PPI was also reduced in both groups. Conclusions Laparoscopic mesh repair of giant hiatal hernia for elderly patients is safe and effective when performed at experienced centers.
Collapse
Affiliation(s)
- Lei Guan
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yusheng Nie
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin Yuan
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huiqi Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Khoma O, Mugino M, Falk GL. Is repairing giant hiatal hernia in patients over 80 worth the risk? Surgeon 2020; 18:197-201. [DOI: 10.1016/j.surge.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 12/25/2022]
|
6
|
Tolone S, Gualtieri G, Savarino E, Frazzoni M, de Bortoli N, Furnari M, Casalino G, Parisi S, Savarino V, Docimo L. Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors. World J Gastrointest Surg 2016; 8:719-728. [PMID: 27933133 PMCID: PMC5124700 DOI: 10.4240/wjgs.v8.i11.719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/17/2016] [Accepted: 09/22/2016] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.
Collapse
|
7
|
Caglià P, Tracia A, Buffone A, Amodeo L, Tracia L, Amodeo C, Veroux M. Physiopathology and clinical considerations of laparoscopic surgery in the elderly. Int J Surg 2016; 33 Suppl 1:S97-S102. [PMID: 27255126 DOI: 10.1016/j.ijsu.2016.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The marked improvements in medical technology and healthcare, lead an increasing number of elderly patients to take advantage of even complex surgical. Recently, laparoscopic surgery has been accepted as a minimally invasive treatment to reduce the morbidity after conventional surgery, and a number of studies have demonstrated the feasibility of laparoscopy with significant advantages also in the elderly. On the other side, the laparoscopic procedure has some drawbacks, including prolonged operation time and impact of carbon dioxide pneumoperitoneum on circulatory and respiratory dynamics. This paper will review the physiopathological implications of laparoscopy, as well as the current literature concerning the most common laparoscopic procedures that are increasingly performed in elderly patients. MATERIALS AND METHODS A systematic review of the current literature was performed using the search engines EMBASE and PubMed to identify all studies reporting the physiopathological implications of laparoscopy in the elderly. The MeSH search terms used were "laparoscopy in the elderly", "physiopathology of laparoscopy", and "pneumoperitoneum". Multiple combinations of the keywords and MeSH terms were used with particular reference to elderly patients. RESULTS Although laparoscopy is minimally invasive in its dissection techniques, the increased physiologic demands present particular challenges among elderly patients. CONCLUSIONS Laparoscopy and its safety in the elderly patients remains a challenge and the evaluation of this approach is therefore mandatory. Although many studies have demonstrated the applicability and advantages of the laparoscopy also in the geriatric population, with low rates of morbidity and mortality, in elderly patients undergoing general surgical procedures the physiologic demands of laparoscopy should be carefully considered.
Collapse
Affiliation(s)
- Pietro Caglià
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Angelo Tracia
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Antonino Buffone
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Luca Amodeo
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Luciano Tracia
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Corrado Amodeo
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| |
Collapse
|
8
|
Thyroid surgery in the elderly: a comparative experience of 400 patients from an Italian university hospital. Int Surg 2016; 99:523-7. [PMID: 25216415 DOI: 10.9738/intsurg-d-14-00030.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to compare disease features and surgical complications of patients undergoing surgery under or over 65 years of age. We performed a retrospective review of patients undergoing thyroidectomy or lobectomy from January 1990 through January 2012 in our Institution. Patients aged over 65 years of age were compared with younger patients on a 1:1 ratio. A total of 2012 patients were operated on during the study period. Two-hundred patients aged > 65 years were compared with 200 patients < 65 years old. In this series, no significant differences were observed concerning surgical complications between groups. At multivariate analysis, masses causing compression, extended approaches and malignant lesions were significant predictors of complications, irrespective of age. Due to longer life expectancy, elderly patients are being operated on more frequently. Safety of thyroid surgery in this population is still debated. We observed no difference in surgical outcomes between elderly and younger patients; however, some features of the diseases impair survival in the former. Age did not increase likeliness of worse outcomes in patients receiving thyroid surgery.
Collapse
|
9
|
Dai JG, Liu QX, Den XF, Min JX. Oesophageal flap valvuloplasty and wrapping suturing prevent gastrooesophageal reflux disease in dogs after oesophageal anastomosis. World J Gastroenterol 2014; 20:17434-17438. [PMID: 25516655 PMCID: PMC4265602 DOI: 10.3748/wjg.v20.i46.17434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/16/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model.
METHODS: We operated on 10 dogs in this study. First, we resected a 5-cm portion of the distal oesophagus and then restored the continuity of the oesophageal and gastric walls by end-to-end anastomosis. A group of five dogs was subjected to the oesophageal flap valvuloplasty and wrapping suturing technique, whereas another group (control) of five dogs was subjected to the stapling technique after oesophagectomy. The symptom of gastrooesophageal reflux was recorded by 24-h pH oesophageal monitoring. Endoscopy and barium swallow examination were performed on all dogs. Anastomotic leakage was observed by X-ray imaging, whereas benign anastomotic stricture and mucosal damage were observed by endoscopy.
RESULTS: None of the 10 dogs experienced anastomotic leakage after oesophagectomy. Four dogs in the new technology group resumed regular feeding, whereas only two of the dogs in the control group tolerated solid food intake. pH monitoring demonstrated that 25% of the dogs in the experimental group exhibited reflux and that none had mucosal damage consistent with reflux. Conversely, both reflux and mucosal damage were observed in all dogs in the control group.
CONCLUSION: The oesophageal flap valvuloplasty and wrapping suturing technique can improve the postoperative quality of life through the long-term elimination of reflux oesophagitis and decreased stricture formation after primary oesophageal anastomosis.
Collapse
|