Safety and Early Clinical Outcomes Following Repair of Very Large Hiatus Hernia in Octogenarians

Dear Editor
We agree with Dr Li that large hiatal hernias present challenges, although we contend that fitness for surgery is the more common conundrum faced when considering elderly populations. Whilst some elderly patients with large hiatus hernias have kyphosis, or occasionally scoliosis, our experience suggests spinal deformity presents greater challenges when operating via an open midline abdominal incision as it shortens the xiphoid to pubis distance. This has less impact when operating laparoscopically. We reported conversion to open surgery was only required in 4.7% of the patients aged > 80, and no conversions resulted from difficulties due to “spinal deformity”. We do not preclude these patients from laparoscopic repair as experienced surgeons rarely encounter difficulties...