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Multicenter Study
. 2025 Jul 18;29(1):235.
doi: 10.1007/s10029-025-03416-6.

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

Tamer A A M Habeeb  1 , Abdulzahra Hussain  2   3 , Alberto Aiolfi  4 , Jose Bueno- Lledó  5 , Massimo Chiaretti  6 , Igor A Kryvoruchko  7 , Mohammad Kermansaravi  8 , Abdelrahman Nimeri  9 , Abd Al-Kareem Elias  10 , Saad Mohamed Ali Ahmed  10 , Esmail Tharwat Kamel Awad  10 , Mohamed A Gadallah  10 , Ahmed Khyrallh  10 , Mohammed H Alsayed  10 , Mohamed Fathy Labib  11 , Sobhy Rezk Ahmed Teama  11 , Abdelhafez Seleem  11 , Mohammed Hassan Elshafey  11 , Mostafa Mahmoud Salama Mostafa  11 , Hamdi Elbelkasi  12 , Mahmoud Ali Abou Zaid  13 , Ahmed Hamdy  14 , Mohamed Ibrahim Abo Alsaad  15 , Maged Z Youssef  16 , Rasha Mohamed Motawea Ali  17 , Ibtsam AbdelMaksoud Mohamed El Shamy  17 , Ahmed Salah Arafa  18 , Ibrahim A Heggy  18 , Sameh Mohamed Naguib  18 , Tamer Wasefy  18 , Mohamed Abozaid  18 , Tamer Mohamed Elshahidy  18 , Abdelshafy Mostafa  18 , Mohamed Elnemr  18 , Abdelrahman Mohamed Hasanin Nawar  18 , Mostafa M Khairy  18 , Ahmed Mesbah Abdelaziz  18 , Abdelfatah H Abdelwanis  18 , Ahmed M El Teliti  18
Affiliations
Multicenter Study

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

Tamer A A M Habeeb et al. Hernia. .

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.

Keywords: Elderly; Frailty; Gastroesophageal reflux disease; Giant HH; Mesh cruroplasty; Nissen fundoplication.

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Conflict of interest statement

Declarations. Ethical approval: All patients received information about their surgical procedures and signed an Informed Consent form prior to surgery. The Institutional Research Ethics Board approved this study, and was retrospectively registered at www.clinicaltrials.gov (NCT06935617). All procedures were conducted following the 1964 Declaration of Helsinki’s ethical standards and subsequent amendments. Consent to participate and publish: Formal written consent was obtained from patients for publication purposes. Competing interests: All authors show no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of inclusion and exclusion criteria
Fig. 2
Fig. 2
KM curve of recurrence free survival between frailty severity
See this image and copyright information in PMC

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