Our Summary

This study looked at the impact of frailty on patients who underwent surgery to repair a paraesophageal hernia (PEH), which is a condition where part of the stomach pushes through the diaphragm and into the chest. They analyzed data from over 10,000 patients who had this surgery between 2015 and 2019. The research found that frail patients, many of whom were elderly and from the lowest income group, had higher rates of complications, longer hospital stays, and higher costs compared to healthier patients. These frail patients were also more likely to die in the hospital and need intensive care after the surgery. Hence, the study concludes that while the surgery is generally safe and effective, doctors should take into account a patient’s overall health and frailty when considering them for this procedure.

FAQs

  1. What is a paraesophageal hernia (PEH)?
  2. What were the findings of the study on the impact of frailty on patients who underwent PEH repair surgery?
  3. What recommendations does the study make for doctors when considering patients for PEH repair surgery?

Doctor’s Tip

Some helpful tips a doctor might give a patient about hiatal hernia repair include:

  1. Follow any pre-operative instructions provided by your healthcare provider, such as fasting before surgery or stopping certain medications.

  2. Make sure to discuss any underlying health conditions or medications you are taking with your healthcare provider before undergoing surgery.

  3. After surgery, follow your doctor’s instructions for post-operative care, including any restrictions on physical activity or dietary changes.

  4. Attend all follow-up appointments to monitor your recovery and address any concerns or complications that may arise.

  5. It’s important to maintain a healthy lifestyle to support the healing process, including eating a balanced diet, staying hydrated, and getting regular exercise.

  6. If you experience any new or worsening symptoms after surgery, such as difficulty swallowing, persistent heartburn, or chest pain, be sure to contact your healthcare provider promptly.

Suitable For

Patients who are typically recommended for hiatal hernia repair are those who are experiencing symptoms such as heartburn, acid reflux, difficulty swallowing, chest pain, regurgitation, or vomiting. These symptoms are often caused by the hiatal hernia allowing stomach acid to back up into the esophagus. Additionally, patients who have complications related to their hiatal hernia, such as bleeding, ulcers, or strictures, may also be recommended for surgery.

In general, patients who are otherwise healthy and able to tolerate surgery are good candidates for hiatal hernia repair. However, as the study mentioned above indicates, patients who are frail, elderly, or have underlying health conditions may be at higher risk for complications and may need to be carefully evaluated before undergoing surgery. It is important for patients to discuss their individual medical history and risk factors with their healthcare provider to determine if hiatal hernia repair is the best course of action for them.

Timeline

Before hiatal hernia repair:

  1. Patient may experience symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation of food.
  2. Patient undergoes diagnostic tests such as endoscopy, barium swallow, and pH monitoring to confirm the presence of a hiatal hernia.
  3. Treatment may include medications to reduce stomach acid, lifestyle changes, and dietary modifications to manage symptoms.

After hiatal hernia repair:

  1. Surgery is performed to repair the hiatal hernia, which involves pulling the stomach back into the abdomen and tightening the opening in the diaphragm.
  2. Patient may experience pain, swelling, and discomfort at the surgical site immediately after the procedure.
  3. Recovery typically involves a hospital stay of 1-2 days, followed by a period of rest and limited activity at home.
  4. Patient may need to follow a special diet and avoid certain foods to prevent complications and allow the surgical site to heal properly.
  5. Follow-up appointments with the surgeon are scheduled to monitor healing and address any concerns or complications that may arise.
  6. Over time, most patients experience relief from their hiatal hernia symptoms and are able to resume normal activities and diet.

What to Ask Your Doctor

  1. What is a hiatal hernia and how is it repaired?
  2. What are the potential risks and complications associated with hiatal hernia repair surgery?
  3. How long is the recovery period after hiatal hernia repair surgery?
  4. Will I need to make any lifestyle changes or follow a special diet after the surgery?
  5. What is the success rate of hiatal hernia repair surgery?
  6. Are there any alternative treatments or non-surgical options for managing hiatal hernia?
  7. How many hiatal hernia repair surgeries have you performed, and what is your success rate?
  8. What is the expected outcome of the surgery in my particular case?
  9. How long will I need to stay in the hospital after the surgery?
  10. Are there any specific factors about my health or medical history that may affect the outcome of the surgery?

Reference

Authors: Lee Y, Huo B, McKechnie T, Agzarian J, Hong D. Journal: Dis Esophagus. 2023 Oct 27;36(11):doad038. doi: 10.1093/dote/doad038. PMID: 37291973