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 - Scorecard - 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

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Clinical Scorecard: Frailty as a Predictor of Recurrence Following Laparoscopic Nissen Fundoplication with Mesh Cruroplasty for Giant Sliding Hiatal Hernia and Severe Reflux Esophagitis in Older Adults: A Multicenter Retrospective Analysis

At a Glance

CategoryDetail
ConditionGiant sliding hiatal hernia with severe reflux esophagitis
Key MechanismsRefractory GERD symptoms due to hypotensive LES and large hiatal defect; surgical repair via laparoscopic Nissen fundoplication with mesh cruroplasty
Target PopulationElderly patients aged ≥ 60 years with giant (>5 cm) sliding hiatal hernia and severe GERD
Care SettingMulticenter surgical centers including academic referral and teaching hospitals

Key Highlights

  • Frailty is a clinical syndrome reflecting diminished physiological reserve and predicts postoperative complications better than chronological age.
  • Mesh cruroplasty may reduce recurrence rates compared to suture cruroplasty alone but carries risks such as dysphagia and esophageal erosion.
  • Hiatal hernia recurrence rates post-repair range from 12–16% radiologic and 3.2–11% clinical, with recurrence influenced by patient factors including frailty.

Guideline-Based Recommendations

Diagnosis

  • Confirm giant sliding hiatal hernia (>5 cm) via imaging and intraoperative measurement.
  • Assess GERD severity with DeMeester score > 100 and abnormal pH impedance testing.
  • Evaluate hypotensive lower esophageal sphincter using high-resolution manometry.

Management

  • Indicate surgery for refractory GERD symptoms after failed medical therapy.
  • Perform laparoscopic Nissen fundoplication combined with cruroplasty; consider mesh reinforcement selectively for large hiatal defects or compromised crura.
  • Incorporate frailty assessment and comprehensive geriatric evaluation in preoperative planning.

Monitoring & Follow-up

  • Conduct standardized follow-up including clinical symptom assessment, barium swallow, endoscopy, or HRM to detect recurrence.
  • Monitor for mesh-related complications such as dysphagia and esophageal erosion.
  • Assess functional status and frailty longitudinally to guide postoperative care.

Risks

  • Higher complication rates in elderly due to comorbidities and frailty.
  • Potential mesh-related adverse events including dysphagia and esophageal erosion.
  • Increased operative difficulty and morbidity with symptomatic recurrence requiring reoperation.

Patient & Prescribing Data

Elderly patients aged ≥ 60 years undergoing laparoscopic repair of giant sliding hiatal hernia with severe reflux esophagitis

Frailty assessment independently predicts hernia recurrence risk; careful patient selection incorporating frailty may improve surgical outcomes regardless of chronological age.

Clinical Best Practices

  • Use comprehensive geriatric assessment including frailty evaluation to guide surgical candidacy in elderly patients.
  • Selectively apply mesh cruroplasty based on hiatal defect size and crural integrity rather than routine use.
  • Implement standardized follow-up protocols with multimodal imaging and functional testing to detect recurrence early.
  • Consider patient-specific algorithms incorporating anatomical and physiological factors to optimize repair durability.
  • Prioritize age-neutral surgical decision-making emphasizing biological resilience over chronological age.

References

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

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