Holding Up at 80: Feasibility and Safety of Elective Type IV Hiatal Hernia Repair in Octogenarians

Background: The aging population has led to an increase in the prevalence of symptomatic paraesophageal hernias (PEHs), particularly among octogenarians. While elective repair is associated with improved outcomes compared to emergency repair, there are limited data on the safety and efficacy of robotic-assisted PEH repair in this high-risk population. Methods: We conducted a retrospective review of patients aged 65-89 who underwent robotic-assisted elective type IV PEH repair by a single surgeon at Mount Sinai Medical Center from 2020 to 2023. Patients were divided into two cohorts: octogenarians (80-89 years) and seniors (65-79 years). Demographics, perioperative outcomes, and complications were analyzed. Results: A total of 38 patients were included, with 15 octogenarians and 23 seniors. The mean ages were 84 ± 2 years and 73 ± 5 years, respectively. The majority of patients were female (73% octogenarians, 87% seniors), and the average body mass index was comparable between cohorts (25 kg/m² ± 3.7 versus 25 ± 4.7). The mean hospital length of stay was 2.7 ± 1.8 days for octogenarians and 2.4 ± 1.8 days for seniors (P = .6). No intraoperative complications or 30-day mortality occurred. Two octogenarians (13%) and three seniors (13%) were readmitted within 30 days. At 6 months, 87% of octogenarians and 69% of seniors reported resolution of preoperative symptoms (P = .3). Conclusions: Robotic-assisted repair of type IV PEHs is a safe and effective option for both octogenarians and seniors. The absence of intraoperative complications and 30-day mortality supports its feasibility in elderly patients, including those in their eighth decade of life. These findings advocate for elective minimally invasive repair in carefully selected patients, regardless of advanced age, and highlight the importance of further studies to validate long-term outcomes.