Abstract
Background: With increasing age, the functional condition of the lower esophageal sphincter is getting weaker. Recent progress in peri-operative intensive care and the development of laparoscopic technique makes antireflux surgery a safe choice of GERD treatment in the elderly.Aim: This work evaluated the long-term results of tailored antireflux surgery in a group of elderly (more than 60 years old) patients.Results: Five hundred and eighty one patients underwent antireflux surgery in our department from 1999 to 2005. Seventy of them (12,0%) were older than 60 years. Exclusion criteria of surgery were ASA IV classification and high grade esophageal dysmotility. Toupet’s wrap was offered to patients with esophageal dysmotility or esophageal sphincter pressure higher than 15mm Hg (16 cases). The rest were offered Nissen-Rossetti’s complete wrap (54 cases). There was zero mortality and no further significant dysphagia. Pathological gastro-esophageal reflux after the surgery was detected in 6 patients (8,6%), which was a higher proportion than in the group of patients under 60 years.Conclusion: Good results of antireflux surgery with zero mortality and low morbidity can be achieved even in the elderly (more frequent use of incomplete Toupet’s wrap).
Similar content being viewed by others
References
Katz PO. Gastroesophageal reflux disease symptoms on antisecretory therapy: acid, non-acid, or no GERD. Rev Gastroenterol Disord. 2006 Summer;6(3):136–45.
Spechler SJ. Epidemiology and natural history of gastro-oesophageal reflux disease. Digestion 1992;51(suppl 1):24–29.
Madisch A, Kulich KR, Malfertheiner P, Ziegler K, Bayerdorffer E, Miehlke S, Labenz J, Carlsson J, Wiklund IK. Impact of reflux disease on general and diseaserelated quality of life — evidence from a recent comparative methodological study in Germany. Z Gastroenterol 2003 Dec;41(12):1137–43.
Costantini M, Crookes PF, Bremner RM, Hoeft SF, Ehsan A, Peters JH, Bremner CG, DeMeester TR. Value of physiologic assessment of foregut symptoms in a surgical practice. Surgery. 1993 Oct;114(4):780–6; discussion 786–7.
Joanne A.P. Wilson: Chapter 56 — Gastroenterologic Disorders. In: Christine K. Cassel (ed.): Geriatric Medicine An Evidence-Based Approach Fourth Edition. New York: Springer-Verlag Inc. 2003.
Pessaux P, Arnaud JP, Delattre JF, Meyer C, Baulieux J, Mosnier H. Laparoscopic antireflux surgery: five-year results and beyond in 1340 patients. Arch Surg. 2005 Oct;140(10):946–51.
Bacak BS, Patel M, Tweed E, Danis P. What is the best way to manage GERD symptoms in the elderly? J Fam Pract. 2006 Mar;55(3):251–4, 258.
Mark H. Beers, Thomas V. Jones, et al. (eds): The Merk Manual of Geriatrics, 3rd Edition, NY: Merck & Co, 2005.
Hungin AP, Rubin GP, O’Flanagan H. Long-term prescribing of proton pump inhibitors in general practice. Br J Gen Pract. 1999 Jun;49(443):451–3.
Morgner-Miehlke A, Koop H, Blum AL, Hermans ML, Miehlke S, Labenz J. Abklärung und Therapie von Refluxbeschwerden. Z Gastroenterol. 2006 May;44(5):399–410.
Bálint A, Máté M, Dubecz A, Solymosi A, Regály — Mérei J. The efficacy of surgical treatment of gastroesophageal reflex disease complicated by respiratory symptoms. Z Gastroenterol. 2004 Dec;42:1055.
Schiefke I, Soeder H, Zabel-Langhennig A, Teich N, Neumann S, Borte G, Mossner J, Caca K. Endoluminal gastroplication: what are the predictors of outcome? Scand J Gastroenterol. 2004 Dec;39(12):1296–303.
Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report. Surg Endosc. 1991;1:138–43
Blomquist AM, Lonroth H, Dalenback J, Lundell L. laparoscopic or open fundoplication? A complete cost analysis. Surg Endosc. 1998;12(10):1209–12
Weber DM. Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg. 2003 Oct;138(10):1083–8.
Bittner HB, Pappas TN. Laparascopic approaches to symptomatic gastroesophageal reflux. Semin Gastroenterol Dis. 1994;5(3):113–9.
Hong D, Swanstrom LL, Khajanchee YS, Pereira N, Hansen PD. Postoperative objective outcomes for upright, supine, and bipositional reflex disease following laparoscopic nissen fundoplication. Arch Surg. 2004 Aug;139(8):848–52.
DeMeester TR. Value of physiologic assessment of foregut symptoms in a surgical practice. Surgery. 1993 Oct;114(4):780–6.
Negre JB, Markkulh HT, Keyrilainen O, Matikainen M. Nissen fundoplication. Results of ten years follow-up.Ann Surg 1983;146:635–8.
Pope CE. Quality of life after anti-reflux surgry. World J Surg 1992;16:355–8.
Lamolz T, Bammer T, Granderath FA, et al. Quality of life and surgical outcome after laparoscopic antireflux surgery in the elderly gastresophageal reflux disease patient. Scand. J. of Gastroenterol. 2001;36(2):116–20
Erenoglu C, Miller A, Schirmer B. Laparoscopic Toupet versus Nissen fundoplication for the treatment of gastroesophageal reflux disease. Int Surg. 2003 Oct–Dec;88(4):219–25.
Ciovica R, Gadenstatter M, Klingler A, Lechner W, Riedl O, Schwab GP. Quality of life in GERD patients: medical treatment versus antireflux surgery. J Gastrointest Surg. 2006 Jul–Aug;10(7):934–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kala, Z., Weber, P., Prochazka, V. et al. Tailored antireflux surgery. J Nutr Health Aging 12, 678–680 (2008). https://doi.org/10.1007/BF03008282
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03008282