Safety and long-term outcome of laparoscopic antireflux surgery in patients in their eighties and older.
BACKGROUND
The elderly have more severe reflux disease and paraesophageal hernias than younger patients, leading to a high failure rate of medical therapy. Laparoscopic antireflux surgery has an overall mortality of 0.1% and a low morbidity, making it a safe and beneficial procedure for the elderly.


METHODS
We performed a retrospective study of octo- and nonogenerians with a mean follow-up of 3.1 years after laparoscopic fundoplication. Thirty (3.5%) patients who were in their eighties or older are reported. Preoperative symptoms, esophageal testing, postoperative symptoms, and satisfaction rate were analyzed.


RESULTS
Fifty-seven percent of patients had paraesophageal hernias. Mean duration of procedures was 146 +/- 49 min, blood loss was 76 +/- 101 ml, and hospitalization was 2.2 +/- 1.0 days. There was one conversion to laparotomy, two intraoperative complications, and no deaths. Follow-up data were available in 93% of patients. Mean follow-up time was 3.1 years. Two died of unrelated causes. At follow-up 96% stated that their surgical outcome was satisfactory. Two patients were suffering from severe symptoms. Overall well-being at follow-up was 7.5 (range 3-10) on a 10-point scale in comparison to 2.2 (range 1-5) before surgery (p = 0.03).


CONCLUSIONS
Laparoscopic surgery is a good option for the treatment of severe gastroesophageal reflux disease in octo- and nonagenarians.
Bammer
T
T
Department of Surgery, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
Hinder
R A
RA
Klaus
A
A
Libbey
J S
JS
Napoliello
D A
DA
Rodriquez
J A
JA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome