Abstract Background Hiatal hernia (HH) is increasingly prevalent among the elderly, yet the optimal surgical approach in this population remains a subject of debate. While hiatoplasty is well established as the foundational step in HH repair, fundoplication is frequently avoided in favor of gastropexy due to concerns over increased morbidity in elderly patients. However, robust evidence in current literature remains limited. This study aims to evaluate perioperative complications, recurrence rates, and long-term outcomes of HH repair in this high-risk group, providing data to help guide surgical decision-making. Methods Patients who underwent HH repair at a high-volume center between 01/2010 and 12/2024 were identified from a prospectively maintained database. Elderly patients were defined as those aged ≥80 years. Collected data included demographics, diagnosis, surgical details, complications, and outcomes. A 1:1 propensity score matching was performed to pair each elderly patient with a younger counterpart (80 years), based on sex, surgical setting (elective vs urgent), ASA score, and year of surgery. Differences between groups were analyzed using univariate logistic regression, with statistical significance set at p 0.05. Results Out of 673 HH repairs, 124 patients were included: 62 elderly and 62 younger (mean age 84 vs 65 years). Baseline characteristics were similar in both groups (73% female, 82% elective, 65% ASAIII). Most patients underwent laparoscopic hiatoplasty with Dor fundoplication. Although not statistically significant, elderly patients had fewer intraoperative and postoperative complications, and a lower rate of major events (CD ≥ IIIa). ICU admission rates and length of stay were comparable (p 0.05). HH recurrences were slightly more frequent and occurred earlier in younger patients (p 0.05). Postoperative complaints were rare, though elderly patients more often reported recurrent GERD or dysphagia (p 0.05). Conclusion Elderly patients undergoing hiatal hernia repair demonstrated perioperative outcomes, recurrence rates, and long-term symptom control comparable to those of younger patients. The use of laparoscopic hiatoplasty with fundoplication in nearly all cases, proved to be safe and effective for this high-risk population. These findings support the use of fundoplication, in carefully selected elderly patients, as a viable and beneficial treatment option.
Cusin et al. (Fri,) studied this question.