Background: Paraesophageal hernias are commonly manifested in the elderly; however, younger adults may be afflicted with this condition. The objective was to determine whether patients aged 50 years and younger have different presentations or outcomes following paraesophageal hernia repair than patients older than 50 years.
Methods: One hundred and thirty-four consecutive patients undergoing open or laparoscopic repair of paraesophageal hernias from October 1995 to December 2000 at the University of Pittsburgh Medical Center were divided into two groups: those aged 50 years or younger (range 34-50, mean 43.7 years) and those older than 50 years (range 51-91 years, mean 67.7 years). Data obtained from the patient included demographics, the presence of gastroesophageal reflux, volvulus, and anemia or bleeding. In addition, duration of procedure, length of hospital stay, morbidity, and mortality were recorded.
Results: Twenty-seven (20%) out of 134 patients undergoing open or laparoscopic paraesophageal hernia repair were aged 50 years or younger. Females outnumbered males by a ratio of 1.3 to 1 in the younger group versus 1.9 to 1 in the older group (p=0.48). Gastroesophageal reflux was significantly more frequent among the patients older than 50 years (p<0.00001). There were no significant differences in the frequencies of gastric volvulus and anemia or bleeding. Operative time and rate of conversion were not significantly different between the two groups. Toupet fundoplication was more frequently used in the patients older than 50 years (p=0.047). Duration of hospital stay was similar (mean 4.6 days for the younger group versus 5.6 days for the older group, p=0.63). There was no significant difference in major complication rate. The 30-day mortality rate was zero for both groups.
Conclusions: Giant paraesophageal hernias are not restricted to the elderly. Twenty percent of patients with paraesophageal hernias in our series were aged 50 years or younger. Younger patients are less likely to present with reflux symptoms than elderly patients. Elderly patients are likely to enjoy the same rate of favorable outcomes as the younger patients.