Is the advanced age a contraindication to GERD laparoscopic surgery? Results of a long term follow-up

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.

Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux

“…Similar results have been shown in some earlier studies, 9,25 although other investigations have found contradictory results. 26,27 The consequence of comorbidities on the rate of recurrence of GERD after laparoscopic antireflux surgery has, to the best of our knowledge, not been studied before. It is possible that the increased risk of reflux recurrence associated with older age and comorbidities exists because only patients with particularly severe and refractory GERD in these groups are selected for surgery, and these patients might also be at a higher risk of recurrence of reflux.…”

The characteristics of antireflux surgery compared to proton pump inhibitor treatment in Korea: a nationwide study using claim data from 2007 to 2016

“…On the other hand, the medical costs among elderly patients in both groups were not significantly different. A study by Fei et al [27] showed that the number of atypical symptoms was higher in the elderly, and the number of typical symptoms was higher in younger patients. In addition, elderly patients are more likely to have poor motility of the esophagus (dysmotility), which is predicted to be insignificant after antireflux surgery.…”

Short- and long-term results after laparoscopic floppy Nissen fundoplication in elderly versus non-elderly patients

“…Several studies have shown the safety and excellent results for LARS also in elderly patients. [ 8 10 19 20 21 ]…”

“…[ 6 7 8 ] Hence, it can be argued that age should not be a contraindication to LARS. However, there are few reports that have evaluated the long-term results after 5 years or more[ 9 10 ] in the elderly patients, after LARS. In this study, we examined the effects of age on the immediate operative outcome and complications of LARS (Nissen fundoplication) in a prospective fashion.…”