Our Summary

This research paper looked at the effects of age on the outcomes of hiatal hernia repairs. Hiatal hernias are quite common and can be found by accident. Some people might choose not to have surgery at first, but often they will need it later as their symptoms get worse.

The researchers looked at the data from a large medical database for all adults who had this surgery between 2000 and 2023. They divided the patients into two groups: those who had elective (chosen) surgery and those who had emergency surgery because of complications like blockages or tissue death. They then compared the outcomes of patients aged 80-89 (octogenarians) with those aged 65-79 (seniors).

The results showed that there were more risks for the older patients in both groups, including higher rates of death, malnutrition, serious infections, breathing problems, pneumonia, blood clots, needing blood transfusions, and needing to go to a nursing facility after the surgery. The risk of death was about 4 times higher for the older patients in both groups.

The researchers concluded that people in their 80s are at a significantly higher risk of problems after hiatal hernia repair surgery compared to people in their late 60s to late 70s. Therefore, they suggest that more thought should be given to doing this surgery before people reach their 80s.

FAQs

  1. What is a hiatal hernia and how is it usually discovered?
  2. What were the key findings of the research on age effects on hiatal hernia repairs?
  3. What are the potential risks associated with hiatal hernia repair surgery for older patients?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hiatal hernia repair is to consider undergoing the surgery before reaching the age of 80, as research suggests that individuals in their 80s are at a significantly higher risk of complications following the procedure compared to those in their late 60s to late 70s. It is important to weigh the potential risks and benefits of the surgery with your healthcare provider to make an informed decision about the timing of the procedure.

Suitable For

Overall, patients who are typically recommended hiatal hernia repair are those who are experiencing significant symptoms such as severe heartburn, regurgitation, difficulty swallowing, chest pain, or vomiting blood. Additionally, patients who have complications such as a hiatal hernia that is causing severe gastroesophageal reflux disease (GERD), Barrett’s esophagus, or esophageal stricture may also be recommended for surgery.

However, as highlighted in the research paper, age is an important factor to consider when recommending hiatal hernia repair. Older patients, especially those in their 80s, are at a higher risk of complications and poor outcomes following surgery. Therefore, it is important for healthcare providers to carefully assess the risks and benefits of surgery for each individual patient, taking into account their age and overall health status.

Timeline

Before hiatal hernia repair:

  • Patient may experience symptoms such as heartburn, chest pain, difficulty swallowing, regurgitation of food or liquids, and feeling full quickly after eating.
  • Patient may undergo diagnostic tests such as endoscopy, barium swallow, and esophageal manometry to confirm the presence of a hiatal hernia.
  • Patient may be prescribed medications such as proton pump inhibitors to manage symptoms.

After hiatal hernia repair:

  • Patient will undergo surgery to repair the hiatal hernia, which may be done laparoscopically or through open surgery.
  • Recovery period typically lasts 4-6 weeks, during which patient may experience pain, bloating, and difficulty swallowing.
  • Patient will be advised to follow a special diet to prevent complications and promote healing.
  • Patient will have follow-up appointments to monitor their progress and ensure the hernia does not recur.
  • Patient may experience improvements in their symptoms such as reduced heartburn and regurgitation after surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hiatal hernia repair include:

  1. What are the risks and benefits of undergoing hiatal hernia repair surgery?
  2. Are there any alternative treatments or lifestyle changes that could help manage my hiatal hernia symptoms?
  3. How experienced are you in performing hiatal hernia repair surgeries?
  4. What is the expected recovery time after the surgery?
  5. What can I expect in terms of pain management after the surgery?
  6. How likely is it that my hiatal hernia will come back after surgery?
  7. Are there any specific dietary or activity restrictions I should follow after the surgery?
  8. What warning signs should I look out for that may indicate complications after the surgery?
  9. Will I need to follow up with you or another healthcare provider after the surgery?
  10. How does age impact the outcomes of hiatal hernia repair surgery, and what considerations should be taken into account for older patients?

Reference

Authors: Kumar SS, Rama M, Koeneman S, Tannouri S, Tatarian T, Palazzo F. Journal: Surg Endosc. 2024 Jul;38(7):3999-4005. doi: 10.1007/s00464-024-10956-y. Epub 2024 Jun 10. PMID: 38858249