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

Abstract

Purpose. Giant sliding hiatal hernias (HH) are prevalent in the elderly population (EP) and often present with multiple comorbidities and a high surgical risk. Frailty has been increasingly recognized as a predictor of surgical outcomes in the EP. This study assessed the rate of recurrent sliding HH following mesh cruroplasty and laparoscopic Nissen fundoplication (LNF), and evaluated frailty as a potential risk factor of recurrence. Methods. This retrospective multicenter study included 266 patients aged≥60 years who underwent mesh cruroplasty and LNF for giant sliding HH (>5 cm) with severe reflux esophagitis (Demeester score>100) between March 2016 and March 2022, stratified into non-recurrence (n=241) and recurrence (n=25) HH. Results. The mean age was 66.92±4.3 years vs. 67.79±3.7 years in the non-recurrence and recurrence group, respectively. Twenty-five (9.4%) patients developed recurrent HH, with a median size of 5.2 cm (4.1–6.0 cm), and the median time from surgery to recurrence was 16 months (13–20 months). Frailty was significantly correlated with recurrence, with moderately and severely frail patients demonstrating higher recurrence rates (44% vs. 17%, p=0.02). Multivariate analysis confirmed that frailty was an independent predictor of recurrence (odds ratio [OR], 1.4; 95% CI, 1.003–1.982; p=0.04). Time to recurrence included mild frailty (75% recurrence rate within 16 months), moderate frailty (90.9% recurrence within 12 months), and severe frailty (80% recurrence within 9 months). Conclusions. Frailty was an independent predictor of HH recurrence. Integrating frailty assessment into preoperative workflows could optimize patient selection and outcomes.