Very large hiatus hernias are often symptomatic, impact quality of life, and are increasingly encountered in aging populations. Laparoscopic repair offers excellent clinical outcomes. However, surgeons can be reluctant to offer surgery to the elderly due to concerns about morbidity and mortality. To determine safety, we evaluated outcomes following repair of very large hiatus hernias in patients aged 80 years and older and compared them to younger patients.
Data were extracted from a prospective database. Patients who underwent operative repair of a very large hiatus hernia (> 50% intrathoracic stomach) between 2000 and 2023 were included and categorized into groups based on age: young (< 70 years), older (70-79 years), and octogenarian (≥ 80 years). Perioperative and early postoperative clinical outcomes were determined and compared.
1353 patients underwent surgery (< 70 years: 733 [54.2%], 70-79 years: 451 [33.3%], and ≥ 80 years: 169 [12.5%]). Rates of total intrathoracic stomach were commonest in octogenarians (11.6% vs. 20.4% vs. 32.5% and p < 0.001). Young and older patients were more likely to undergo elective surgery for heartburn (56.6% vs. 44.4% vs. 29.0% and p < 0.001), whereas octogenarians more likely underwent emergency surgery for gastric volvulus (5.4% vs. 6.6% vs. 14.5% and p = 0.019). Conversion to open surgery (1.1% vs. 1.1% vs. 5.0% and p = 0.002) and length of stay (2.69 vs. 3.19 vs. 4.62 days and p < 0.001) were greater in the octogenarian group. Major complications (4.2% vs. 5.1% vs. 8.1% and p = 0.120) and return to theater rates (2.6% vs. 2.9% vs. 2.7% and p = 0.925) were similar. Thirty-day mortality rates were low for all groups but highest in octogenarians (0.3% vs. 0.4% vs. 1.8% and p = 0.048). Adverse outcomes were more likely with emergency presentations, which were more common in octogenarians.
Despite a higher rate of emergency surgery in octogenarians-major complications and overall mortality rates are still acceptably low. Repair of very large symptomatic hiatus hernia should not be withheld from patients aged over 80 who are otherwise fit.

© 2025 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).