Laparoscopic Hiatal Repair and Gastropexy without Fundoplication of Hiatal Hernia in Elderly Patients with High Dysphagia Score: A Case Series of Four Patients.

introductionHiatal repair with fundoplication for hiatal hernia (HH) could cause postoperative dysphagia. In the aging society, the number of patients with HH type III/IV and severe dysphagia is increasing. In this case, the surgical priority is to resolve the dysphagia. Recent papers have reported that laparoscopic hiatal repair without fundoplication can be an alternative procedure. Nevertheless, the indication for hiatal repair without fundoplication should be carefully considered. CASE PRESENTATION: We performed laparoscopic hiatal repair and gastropexy without fundoplication in four patients with HH type III and high dysphagia scores. The median age was 84 (range 81-96) years, and the median values in the updated Charlson Comorbidity Index (uCCI) were 2 (2-5). Dysphagia scores were high (3, n = 2 and 4, n = 2). The media operative time was 196 (57-249) minutes, and the postoperative hospital stay was 9.5 (8-12) days. Only one case experienced HH recurrence (Type I) on endoscopy and computed tomography but did not have heartburn or dysphagia while on medication. The FSSG scores significantly decreased from 29 (26-35) to 4 (0-7) after surgery (p = 0.0035). Compared with those of four patients who underwent conventional surgeries (hiatal repair with Nissen fundoplication) during the same period, patients undergoing hiatal repair and gastropexy without fundoplication were relatively older (84 [81-96] vs. 74.5 [72-79]), had higher uCCI values (2 [2-5] vs. 1 [0-2]), and higher dysphagia scores (3.5 [3-4] vs. 1 [0-1]). However, there were no differences in the surgical outcomes and postoperative FSSG scores.

conclusionsLaparoscopic hiatal repair and gastropexy without fundoplication is feasible in elderly patients with HH type III and high dysphagia scores.