TY - JOUR
T1 - Outcomes of laparoscopic paraesophageal hernia repair in elderly and high-risk patients
AU - Gangopadhyay, Noopur
AU - Perrone, Juan M.
AU - Soper, Nathaniel J.
AU - Matthews, Brent D.
AU - Eagon, J. Christopher
AU - Klingensmith, Mary E.
AU - Frisella, Margaret M.
AU - Brunt, L. Michael
N1 - Funding Information:
Supported in part by an educational grant from Ethicon Endosurgery Inc., and by the Washington University Institute for Minimally Invasive Surgery.
PY - 2006/10
Y1 - 2006/10
N2 - Background: This study examines the impact of age and comorbidities on complications and outcomes of laparoscopic (Lap) paraesophageal hernia (PEH) repair. Methods: Data were collected prospectively on all patients who underwent Lap PEH repair from January 1995 through June 2005. Pre- and postoperative variables including complications were analyzed. Patients were stratified by age (Group [Gr.] 1, <65 years; Gr. 2, 65 to 74 years; Gr. 3, ≥75 years) and American Society of Anesthesiology (ASA) class (1 and 2 vs 3 and 4). Statistical analysis was performed using 1-way ANOVA, chi-square, and Fisher exact test. Results: Overall, 171 patients underwent Lap PEH repair. Mean patient age was 65 ± 15 years, mean ASA class 2.4 ± 0.5, gender 72% female, and mean operating time 173 ± 49 min. Patients in Gr. 3 had a significantly higher ASA class (Gr. 1, 2.3 ± 0.6; Gr. 2, 2.5 ± 0.5; Gr. 3, 2.6 ± 0.5) and longer postoperative length of stay (LOS) compared with Gr. 1 (P < 0.05). Esophageal lengthening was required in 10.4% of patients in Gr. 3 versus 2.6% in Gr. 1 and 2.1% in Gr. 2 (P = 0.079). Total complication rates were 17.1% in Gr. 1, 22.4% in Gr. 2, and 27.7% in Gr. 3 (P = not significant [NS]). Most complications were minor; grade 2 or higher complications occurred in 10.5% of patients in Gr. 1, 8.3% in Gr. 2, and 8.5% in Gr. 3 (P = NS). There was 1 death (Gr. 2) on postoperative day 18 due to a myocardial infarction (mortality rate = 0.6%). Mean follow-up was 25.3 ± 20.6 months. Postoperative symptoms of heartburn and regurgitation were similar between groups as was antisecretory medication use. Anatomic failure of the repair occurred in 23.7% of patients with adequate follow-up: 26.7% in Gr. 1, 15.4% in Gr. 2, and 27.8% in Gr. 3 (P = NS). Reoperation was performed in 1 of 32 (3.1%) failures. Conclusions: Lap PEH repair is safe in elderly and properly selected high-risk patients, although complication rates are higher than in younger patients. Most patients have a good symptomatic outcome irrespective of their age, but the anatomic recurrence rates remain a concern for all age groups.
AB - Background: This study examines the impact of age and comorbidities on complications and outcomes of laparoscopic (Lap) paraesophageal hernia (PEH) repair. Methods: Data were collected prospectively on all patients who underwent Lap PEH repair from January 1995 through June 2005. Pre- and postoperative variables including complications were analyzed. Patients were stratified by age (Group [Gr.] 1, <65 years; Gr. 2, 65 to 74 years; Gr. 3, ≥75 years) and American Society of Anesthesiology (ASA) class (1 and 2 vs 3 and 4). Statistical analysis was performed using 1-way ANOVA, chi-square, and Fisher exact test. Results: Overall, 171 patients underwent Lap PEH repair. Mean patient age was 65 ± 15 years, mean ASA class 2.4 ± 0.5, gender 72% female, and mean operating time 173 ± 49 min. Patients in Gr. 3 had a significantly higher ASA class (Gr. 1, 2.3 ± 0.6; Gr. 2, 2.5 ± 0.5; Gr. 3, 2.6 ± 0.5) and longer postoperative length of stay (LOS) compared with Gr. 1 (P < 0.05). Esophageal lengthening was required in 10.4% of patients in Gr. 3 versus 2.6% in Gr. 1 and 2.1% in Gr. 2 (P = 0.079). Total complication rates were 17.1% in Gr. 1, 22.4% in Gr. 2, and 27.7% in Gr. 3 (P = not significant [NS]). Most complications were minor; grade 2 or higher complications occurred in 10.5% of patients in Gr. 1, 8.3% in Gr. 2, and 8.5% in Gr. 3 (P = NS). There was 1 death (Gr. 2) on postoperative day 18 due to a myocardial infarction (mortality rate = 0.6%). Mean follow-up was 25.3 ± 20.6 months. Postoperative symptoms of heartburn and regurgitation were similar between groups as was antisecretory medication use. Anatomic failure of the repair occurred in 23.7% of patients with adequate follow-up: 26.7% in Gr. 1, 15.4% in Gr. 2, and 27.8% in Gr. 3 (P = NS). Reoperation was performed in 1 of 32 (3.1%) failures. Conclusions: Lap PEH repair is safe in elderly and properly selected high-risk patients, although complication rates are higher than in younger patients. Most patients have a good symptomatic outcome irrespective of their age, but the anatomic recurrence rates remain a concern for all age groups.
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U2 - 10.1016/j.surg.2006.07.001
DO - 10.1016/j.surg.2006.07.001
M3 - Article
C2 - 17011895
AN - SCOPUS:33748961461
SN - 0039-6060
VL - 140
SP - 491
EP - 499
JO - Surgery
JF - Surgery
IS - 4
ER -