Obese subjects candidate to bariatric surgery have a high risk of disruption of EGJ morphology. In particular, obese patients with hiatal hernia often refer pre-operative presence of GERD symptoms. Testing obese patients with HRM before undergoing bariatric surgery, especially for restrictive procedures, can be useful for assessing presence of hiatal hernia.
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.
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