Back to Program

Background: Giant paraesophageal hernias (PEH) involve herniation of a substantial portion of the stomach and/or other viscera into the posterior mediastinum. When these hernias are discovered they are usually symptomatic and occur more commonly in the elderly. The laparoscopic approach has gained favor to manage PEHs because of reported excellent results, low morbidity and very low mortality. There is a perceived risk of operating on elderly patients with symptomatic PEHs because of concern for complications including death. There also remains a question of benefit. We sought to review our clinical and quality of life outcomes with giant PEH repairs in patients 70 years and older.Methods: We performed a retrospective chart review of consecutive patients with age greater than or equal to 70 years with giant PEHs (> 5 cm and/or Type II-IV) undergoing repair from October 2003 to October 2009. Demographic, operative, clinical and quality of life data were collected from the clinic chart, hospital medical record and patient phone interviews. Quality of life data were gathered using the Quality of Life in Reflux and Dyspepsia Questionnaire (QOLRAD), GERD-HRQoL and Dysphagia Severity Score Index. Standard statistical analysis was performed using SPSS 18.Results: Fifty-eight consecutive patients with median age of 80 years (range: 70 - 91 yrs) presented for repair of symptomatic, giant PEH. There were 34 females. Nine patients presented urgently or emergently with symptoms of incarceration/strangulation. There was no 30-day or in hospital mortality. Nine patients experienced at least one major morbidity, and 9 patients experienced a minor morbidity. At a mean follow-up 1.2 years (range: 2 m to 5 yrs), 81% of patients were entirely symptom free compared to baseline (P<0.0001). Short-term QOLRAD measured 4-6 weeks post-operatively improved significantly from 5.1 to 6.1 (p =0.002). Long term QOLRAD measured at a minimum of one year from the date of surgery improved from 4.8 to 6.6 (p < 0.001). Long term GERD HRQoL scores improved from 14 to 3.84 (p = 0.003). There was no difference in the Dysphagia Severity Score Index. Conclusions: These data support repair of symptomatic giant paraesophageal hernias in patients aged 70 years or greater. These hernias can be repaired in the elderly with minimal surgical mortality and acceptable morbidity in both the elective and emergent setting. A significant number of patients undergoing repair can expect resolution of the symptoms they suffered from pre-operatively. These findings are further supported by significant improvements in both short-term and long-term quality of life.