Abstract
Purpose
Laparoscopic antireflux surgery (LARS) has long been introduced as an alternative method for the treatment of gastroesophageal reflux disease (GERD) in young adults. However, the safety of this procedure and the associated improvement in the quality of life for the elderly are rarely discussed. This study compared the results between young and elderly patients who underwent laparoscopic fundoplication for the treatment of GERD.
Methods
From January 1999 to January 2006, there were 231 adult patients who underwent LARS for GERD at a single institute. Among all patients, 33 patients were older than 70 years old (14.3%, 73.0 ± 1.9, range 70–76), 198 patients were younger than 70 years old (85.7%, 46.6 ± 11.5, range 20–69). The clinical characteristics, operation time, postoperative hospital stay, surgical complications, and quality of life were retrospectively analyzed.
Results
The mean operation time had no significant difference between the younger group and the elderly group. The mean postoperative hospital stay in the elderly group was slightly longer than the younger group (4.1 ± 2.5 days vs 3.4 ± 1.3 days, P = 0.19). There were no mortalities and no major complications found in each group. No patients required conversion to an open procedure. Four patients had minor complications (three in the elderly group, rate: 9.0%; one in the younger group, rate: 0.5%, P < 0.05). There were two patients in the nonelderly group who had recurrence. A comparison of the preoperative and postoperative Gastro-Intestinal Quality of Life Index (GIQLI) scores showed significant improvements (99.3 ± 19.2 points, and 110.2 ± 20.6 points, respectively, P < 0.05) with no significant difference between the two groups.
Conclusion
Laparoscopic antireflux surgery thus appears to provide an equivalent degree of safety and symptomatic relief for elderly patients with GERD as that observed in young patients.
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References
Chen PC, Wu CS, Chang-Chien SC, Liaw YF. Comparison of Olympus GIF-P2 and GIF-K panendoscopy J. Formos Med Assoc 1979;78:136–140.
Yeh C, Hsu CT, Ho AS, Sampliner RE, Fass R. Erosive esophagitis and Barrett’s esophagus in Taiwan: a higher frequency than expected. Dig Dis Sci 1997;42:702–706.
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1991;1:138–143.
Geagea T. Laparoscopic Nissen fundoplication: preliminary report on ten cases. Surg Endosc 1991;5:170–173.
Arnavd JP, Pessaux P, Ghavami B, Flamont JB, Trebuchet G, Meyer C, et al. Laparoscopic fundoplication for gastroesophageal reflux: multicenter study of 1 470 cases. Chirurgie 1999;124:516–522.
Terry M, Smith CD, Branum GD, Galloway K, Waring JP, Hunter JG. Outcomes of laparoscopic Nissen fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Surg Endosc 2001;15:691–699.
Hinder RA, Filipi CJ, Wetscher G, Neary P, DeMeester TR. Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 1994;220:472–483.
Hunter JG, Trus TL, Branum GD, Waring JP, Wood WL. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 1996;223:673–687.
Swanstrom L, Wayne R. Spectrum of gastrointestinal symptoms after laparoscopic fundoplication. Am J Surg 1994;167:538–541.
Eshraghi N, Farahmand M, Soot SJ, Rand-Luby L, Deveney DW, Sheppard BC. Comparison of outcomes of open versus laparoscopic Nissen fundoplication performed in a single practice. Am J Surg 1998;175:371–374.
European Association for Endoscopic Surgery Consensus Develpoment Conference. Laparoscopic antireflux surgery for gastroesophagealreflux disease (GERD). Surg Endosc 1997;11:413–426.
Laine S, Rantala A, Gullichsen R, Ovaska J. Laparoscopic vs conventional Nissen fundoplication: a prospective randomized study. Surg Endosc 1997;11:441–444.
Trus TL, Laycock WS, Wo JM, Waring JP, Branum GD. Laparoscopic antireflux surgery in the elderly. Am J Gastroenterol 1998;93:351–353.
Kamolz T, Granderath FA, Bammer T, Pasiut M, Pointner P. Failed antireflux surgery: surgical outcome of laparoscopic refundoplication in the elderly. Hepato-Gastroenterology 2002;49:865–868.
Weber DM. Laparoscopic Surgery: an excellent approach in the elderly. Arch Surg 2003;138:1083–1088.
Lopez CB, Cid JA, Poves I, Bottonica C, Villegas L, Memon MA. Laparoscopic surgery in the elderly patient. Surg Endosc 2003;17:333–337.
Bammers T, Hinder RA, Klaus A, Libbey JS, Napoliello DA, Rodriquez JA. Safety and long-term outcome of laparoscopic antireflux surgery in patients in their eighties and older. Surg Endosc 2002;16:40–42.
Khajanchee YS, Urbach DR, Butler N, Hansen PD, Swanstrom LL. Laparoscopic antireflux surgery in the elderly: surgical outcome and effect on quality of life. Surg Endosc 2002;16:25–30.
Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Is laparoscopic antireflux surgery for gastroesophageal reflux disease in the elderly safe and effective. Surg Endosc 1999;13:838–842.
Huang MT, Lai IR, Wei PL, Wu CC, Lee WJ. Laparoscopic Nissen fundoplication for reflux esophagitis: the initial experience. Formos J Surg 2000;33:66–71.
Lai IR, Lee YC, Lee WJ, Yuan RH. Comparison of open and laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease in Taiwanese. J Formos Med Assoc 2002;101:547–551.
Collen MJ, Abdulian JD, Chen YK. Gastroesophageal reflux disease in the elderly: more severe disease that requires aggressive therapy. Am J Gastroenterol 1995;90:1053–1057.
Mold JW, Reed LE, Davis AB, Allen ML, Decktor DL, Robinson M. Prevalence of gastroesophageal reflux disease in elderly patients in a primary care setting. Am J Gastroenterol 1991;86:965–970.
Zhu H, Pace F, Sangaletti O, Porro BG. Features of symptomatic gastroesophageal reflux in elderly patients. Scan J Gastroenterol 1993;28:235–238.
Fuchs KH, Feussener H, Bonavina L, Collard JM, Coosemans W. Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. Endoscopy 1997;29:298–308.
Kamolz T, Bammer T, Granderath FA, Pasiut M, Pointner R. Quality of life and surgical outcome after laparoscopic antireflux surgery in the elderly gastroesophageal reflux disease patient. Scand J Gastroenterol 2001;2:116–120.
Dallemagne B, Weerts JM, Jeahes C, Markiewicz S. Results of laparoscopic Nissen fundoplication. Hepatogastroenterol 1998;45:1338–1343.
Gadenstatter M, Klingler A, Prommegger R, Hinder RA, Wetscher GJ. Laparoscopic partial posterior fundoplication provides excellent intermediate results in GERD patients with impaired esophageal peristalsis. Surgery 1999;126:548–552.
Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM. Schmulling C. Neugebauer E, et al. Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 1995;82:216–222.
Jentschura D, Winkler M, Strohmeier N, Rumstadt B. Hagmuller E. Quality of life after curative surgery for gastric cancer: A comparison between total gastrectomy and subtotal gastric resection. Hepatogastroenterology 1997;44:1137–1142.
Slim K, Bousquet J, Kwiatkowski F, Lescure G. Pezet D. Chipponi J. Quality of life before and after laparoscopic fundoplication. Am J Surg 2001;180:41–45.
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Wang, W., Huang, MT., Wei, PL. et al. Laparoscopic antireflux surgery for the elderly: A surgical and quality-of-life study. Surg Today 38, 305–310 (2008). https://doi.org/10.1007/s00595-007-3619-0
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DOI: https://doi.org/10.1007/s00595-007-3619-0