Frailty predicts recurrence after laparoscopic Nissen fundoplication with mesh cruroplasty for giant sliding hiatal hernia with severe reflux esophagitis in elderly patients: a multicenter retrospective study - Report - MDSpire

Frailty predicts recurrence after laparoscopic Nissen fundoplication with mesh cruroplasty for giant sliding hiatal hernia with severe reflux esophagitis in elderly patients: a multicenter retrospective study

  • By

  • Tamer. A. A. M. Habeeb

  • Abdulzahra Hussain

  • Alberto Aiolfi

  • Jose Bueno- Lledó

  • Massimo Chiaretti

  • Igor A. Kryvoruchko

  • Mohammad Kermansaravi

  • Abdelrahman Nimeri

  • Abd Al-Kareem Elias

  • Saad Mohamed Ali Ahmed

  • Esmail Tharwat Kamel Awad

  • Mohamed. A. Gadallah

  • Ahmed Khyrallh

  • Mohammed H. Alsayed

  • Mohamed Fathy Labib

  • Sobhy Rezk Ahmed Teama

  • Abdelhafez Seleem

  • Mohammed Hassan Elshafey

  • Mostafa Mahmoud Salama Mostafa

  • Hamdi Elbelkasi

  • Mahmoud Ali Abou Zaid

  • Ahmed Hamdy

  • Mohamed Ibrahim Abo Alsaad

  • Maged Z. Youssef

  • Rasha Mohamed Motawea Ali

  • Ibtsam AbdelMaksoud Mohamed El Shamy

  • Ahmed Salah Arafa

  • Ibrahim A. Heggy

  • Sameh Mohamed Naguib

  • Tamer Wasefy

  • Mohamed Abozaid

  • Tamer Mohamed Elshahidy

  • Abdelshafy Mostafa

  • Mohamed Elnemr

  • Abdelrahman Mohamed Hasanin Nawar

  • Mostafa M. Khairy

  • Ahmed Mesbah Abdelaziz

  • Abdelfatah H. Abdelwanis

  • Ahmed M. El Teliti

  • July 18, 2025

  • 0 min

Share

Frailty Predicts Recurrence After Laparoscopic Nissen Fundoplication in Elderly Hiatal Hernia Patients

Overview

This multicenter retrospective study of 266 elderly patients undergoing laparoscopic Nissen fundoplication with mesh cruroplasty for giant sliding hiatal hernia found that frailty independently predicts hernia recurrence. Patients were stratified by recurrence status, revealing a significant association between frailty severity and postoperative recurrence rates over a standardized three-year follow-up.

Background

Sliding hiatal hernia (HH) prevalence increases with aging, affecting nearly a quarter of the elderly population, often accompanied by gastroesophageal reflux disease (GERD). Surgical repair, primarily indicated for refractory GERD, typically involves fundoplication combined with cruroplasty, with mesh reinforcement used selectively due to potential complications. Frailty, a syndrome of diminished physiological reserve distinct from chronological age, has emerged as a critical predictor of surgical outcomes in elderly patients, yet its role in HH recurrence has not been previously evaluated.

Data Highlights

ParameterNon-Recurrent Group (n=241)Recurrent Group (n=25)
Age ≥ 60 years100%100%
Giant Sliding HH (>5 cm)100%100%
Severe GERD (DeMeester >100)100%100%
Frailty SeverityLower prevalenceHigher prevalence
Follow-up Duration3 years3 years
Recurrence Rate0%9.4%

Key Findings

  • Frailty independently predicts recurrence of giant sliding hiatal hernia after laparoscopic Nissen fundoplication with mesh cruroplasty in patients aged ≥ 60 years.
  • Recurrence was defined as ≥ 2 cm proximal displacement of the gastroesophageal junction confirmed by clinical and radiologic criteria.
  • The study included 266 elderly patients, with 25 experiencing recurrence during a three-year follow-up.
  • Mesh cruroplasty was applied selectively for large hiatal defects (>5 cm) with severe GERD refractory to medical therapy.
  • Frailty assessment provided superior risk stratification compared to chronological age alone in predicting postoperative outcomes.

Clinical Implications

Preoperative frailty assessment should be integrated into the surgical evaluation of elderly patients with giant sliding hiatal hernia to better predict recurrence risk and guide patient selection. Tailoring surgical approaches and postoperative management based on frailty status may improve long-term outcomes and reduce the need for reoperation. Age alone should not preclude surgery when frailty is carefully evaluated.

Conclusion

Frailty is a significant independent predictor of hiatal hernia recurrence following laparoscopic Nissen fundoplication with mesh cruroplasty in elderly patients. Incorporating frailty assessments into preoperative evaluation enhances risk stratification beyond chronological age, informing surgical decision-making and postoperative care.

References

  1. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines 2022 -- GERD Surgery for Type I Hiatal Hernia
  2. Oor et al. 2021 -- Frailty and Surgical Outcomes in Elderly Patients
  3. National Surgical Quality Improvement Program (NSQIP) Database Analysis 2020 -- Frailty Predicts Postoperative Complications

Original Source(s)

Frailty predicts recurrence after laparoscopic Nissen fundoplication with mesh cruroplasty for giant sliding hiatal hernia with severe reflux esophagitis in elderly patients: a multicenter retrospective study

  • by Tamer. A. A. M. Habeeb, Abdulzahra Hussain, Alberto Aiolfi, Jose Bueno- Lledó, Massimo Chiaretti, Igor A. Kryvoruchko, Mohammad Kermansaravi, Abdelrahman Nimeri, Abd Al-Kareem Elias, Saad Mohamed Ali Ahmed, Esmail Tharwat Kamel Awad, Mohamed. A. Gadallah, Ahmed Khyrallh, Mohammed H. Alsayed, Mohamed Fathy Labib, Sobhy Rezk Ahmed Teama, Abdelhafez Seleem, Mohammed Hassan Elshafey, Mostafa Mahmoud Salama Mostafa, Hamdi Elbelkasi, Mahmoud Ali Abou Zaid, Ahmed Hamdy, Mohamed Ibrahim Abo Alsaad, Maged Z. Youssef, Rasha Mohamed Motawea Ali, Ibtsam AbdelMaksoud Mohamed El Shamy, Ahmed Salah Arafa, Ibrahim A. Heggy, Sameh Mohamed Naguib, Tamer Wasefy, Mohamed Abozaid, Tamer Mohamed Elshahidy, Abdelshafy Mostafa, Mohamed Elnemr, Abdelrahman Mohamed Hasanin Nawar, Mostafa M. Khairy, Ahmed Mesbah Abdelaziz, Abdelfatah H. Abdelwanis, Ahmed M. El Teliti

  • July 18, 2025

Related Content

Outcomes, Indications, and Complications of Revisional Surgery Following Biliopancreatic Diversion in a High-Volume Surgical Center

AAE Revises Dental Trauma Guidance

Recommendations outline splinting, replantation timing, imaging, and long-term surveillance strategies for permanent tooth injuries.

Online Program Eases Pediatric Trauma Stress

Randomized trial evaluated therapist-assisted intervention among pediatric patients with persistent symptoms 1 month following trauma