Background

The incidence of PEH increases with BMI and age. Hiatal hernia repair/antireflux surgery alone portends increased risk of recurrence and does not address comorbidities. The safety and feasibility of simultaneous PEH and RYGB is not well elucidated in patients aged 65 years and older.

Methods

A multicenter retrospective review of patients who underwent simultaneous PEH repair and RYGB at > 65 years from 2008-2022 was performed. Patient demographics, hernia characteristics, postoperative complications and weight loss data were collected. A Fisher’s exact t-test was used to analyze the categorical variables. Data are summarized as mean ± standard deviation.

Results

A total of 40 patients were included (82.5% female, age 69.2 years; BMI 39.4 kg/m2) with a mean follow-up of 32.3 months. Average hernia size was 5.8 cm. Mesh was not used in 37 cases (92.5%), with only 3 (7.5%) reported recurrences. Postoperative complications (n=7) and mortality rates (n=1, 2.5%) as well as readmission (7.5%), reoperation (5%) and reintervention (7.5%) rates at 30-days were reported. We noted a 27% diabetes remission after surgery. There was a statistically significant resolution in GERD (p<0.001), hypertension (p=0.019) and sleep apnea (p=0.014). Mean BMI at 3, 6 and 12 months was 33.5, 30.7 and 29.3 kg/m2 respectively and mean %TWL was 25.4%.

Conclusions

Simultaneous PEH repair and RYGB is safe and efficient in the elderly. Patient selection is crucial to reduce postoperative complications and obtain favorable outcomes such as weight loss, low risk of hernia recurrence and considerable comorbidities resolution.