[Outcome after laparoscopic antireflux surgery: fundoplication and re-fundoplication in the elderly].
OBJECTIVE
Treatment of gastroesophageal reflux disease (GERD) in the elderly follows the same principles as for any adult patient. The indication for laparoscopic antireflux surgery (LARS) often depends on the age of the patient. The aim of this prospective study was to evaluate the surgical outcome including quality of life after LARS and laparoscopic "redo-surgery" in patients older than 65 years.


METHODS
Since 1993, 75 patients with a mean age of 71 years have been treated with laparoscopic "floppy" Nissen (n = 53) or Toupet (n = 22) fundoplication. Thirteen patients underwent laparoscopic redo-surgery after failed LARS. Quality of life (GIQLI) was assessed before surgery and 3 months and 1 year after surgery, with 24-h pH monitoring and esophageal manometry being performed.


RESULTS
Intraoperative complications occurred in two patients with primary LARS, successfully managed laparoscopically. The conversion and mortality rate was 0%. In two patients postoperative complications occurred. Three months and 1 year after surgery 24-h pH monitoring and esophageal manometry showed normal values in all patients. GIQLI increased significantly after surgery and is comparable to that of healthy individuals. One patient suffered from severe dysphagia and required dilatation. In 13 patients who underwent laparoscopic refundoplication, redo procedure was completed laparoscopically in 12 patients. In one patient conversion was necessary because of severe bleeding from the spleen. Data of esophageal manometry and 24-h pH monitoring showed normal values in all patients after redo-surgery. Three months and 1 year after laparoscopic reoperation the general score of GIQLI increased significantly (p < 0.01) and reached a level equivalent to that of comparable healthy individuals.


CONCLUSIONS
Laparoscopic fundoplication and refundoplication in the elderly patient is a safe and effective treatment in GERD and improves quality of life significantly. Age should not be longer a contraindication to LARS.
Granderath
F A
FA
Abteilung für Allgemeinchirurgie, A. ö. Krankenhaus Zell am See, Osterreich. FAGZELLAMSEE@yahoo.com
Kamolz
T
T
Schweiger
U M
UM
Bammer
T
T
Pointner
R
R
D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011788:Quality of Life; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome