470. HIATAL HERNIA REPAIR IN THE ELDERLY: A PROPENSITY SCORE–MATCHED COHORT STUDY OF PERIOPERATIVE OUTCOMES AND LONG-TERM RESULTS
Bibliographic record
Abstract
Abstract Background Hiatal hernia (HH) is increasingly prevalent among the elderly, yet the optimal surgical approach in this population remains a subject of debate. While hiatoplasty is well established as the foundational step in HH repair, fundoplication is frequently avoided in favor of gastropexy due to concerns over increased morbidity in elderly patients. However, robust evidence in current literature remains limited. This study aims to evaluate perioperative complications, recurrence rates, and long-term outcomes of HH repair in this high-risk group, providing data to help guide surgical decision-making. Methods Patients who underwent HH repair at a high-volume center between 01/2010 and 12/2024 were identified from a prospectively maintained database. Elderly patients were defined as those aged ≥80 years. Collected data included demographics, diagnosis, surgical details, complications, and outcomes. A 1:1 propensity score matching was performed to pair each elderly patient with a younger counterpart (<80 years), based on sex, surgical setting (elective vs urgent), ASA score, and year of surgery. Differences between groups were analyzed using univariate logistic regression, with statistical significance set at p < 0.05. Results Out of 673 HH repairs, 124 patients were included: 62 elderly and 62 younger (mean age 84 vs 65 years). Baseline characteristics were similar in both groups (73% female, 82% elective, 65% ASAIII). Most patients underwent laparoscopic hiatoplasty with Dor fundoplication. Although not statistically significant, elderly patients had fewer intraoperative and postoperative complications, and a lower rate of major events (CD ≥ IIIa). ICU admission rates and length of stay were comparable (p > 0.05). HH recurrences were slightly more frequent and occurred earlier in younger patients (p > 0.05). Postoperative complaints were rare, though elderly patients more often reported recurrent GERD or dysphagia (p > 0.05). Conclusion Elderly patients undergoing hiatal hernia repair demonstrated perioperative outcomes, recurrence rates, and long-term symptom control comparable to those of younger patients. The use of laparoscopic hiatoplasty with fundoplication in nearly all cases, proved to be safe and effective for this high-risk population. These findings support the use of fundoplication, in carefully selected elderly patients, as a viable and beneficial treatment option.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".