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.

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.