Abstract
BackgroundIn this prospective non randomized observational cohort study we have evaluated the influence of age on outcome of laparoscopic total fundoplication for GERD.MethodsSix hundred and twenty consecutive patients underwent total laparoscopic fundoplication for GERD. Five hundred and twenty-four patients were younger than 65 years (YG), and 96 patients were 65 years or older (EG). The following parameters were considered in the preoperative and postoperative evaluation: presence, duration, and severity of GERD symptoms, presence of a hiatal hernia, manometric and 24 hour pH-monitoring data, duration of operation, incidence of complications and length of hospital stay.ResultsElderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in comparison with younger patients. The duration of the operation was similar between the two groups. The incidence of intraoperative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 93.0% of young patients and in 88.9% of elderly patients (p = NS).ConclusionsLaparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients.
Highlights
In this prospective non randomized observational cohort study we have evaluated the influence of age on outcome of laparoscopic total fundoplication for gastroesophageal reflux disease (GERD)
Instrumental examinations comprised upper gastrointestinal endoscopy, esophageal manometry and 24-h pH monitoring; for pHmetric and manometric examinations, patients had to suspend at least for a week the assumption of antisecretive and antiacid drugs, and stop the assumption of prokinetic drugs and other pharmaceutical products that could interfere with the basal tone of the lower esophageal sphincter (LES) at least 24 hours before the investigations [5,6,7]
No statistically significant differences in the mean LES pressure were found when the two groups were compared (p = NS) but the elderly group (EG) had a higher rate of impaired esophageal peristalsis in comparison with their younger counterparts (P < 0.05) (Table 4)
Summary
In this prospective non randomized observational cohort study we have evaluated the influence of age on outcome of laparoscopic total fundoplication for GERD. Digestive diseases represent very common causes of morbidity and mortality in the elderly patients [1]. Among them gastroesophageal reflux disease (GERD) is usually more severe than in younger patients, and is frequently under-diagnosed and less treated [1]. The advent of laparoscopic surgery and its diffusion [2], has greatly reduced the morbidity of fundoplication antireflux surgery and it is considered the surgical
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