Laparoscopic antireflux surgery in the elderly.
BACKGROUND
Both gastroesophageal reflux and paraesophageal hernias are more common in the elderly, but often these patients are not referred for surgery because of their age. In this study we determined the outcome for laparoscopic antireflux surgery in patients aged 70 years or older, in whom either symptoms of gastroesophageal reflux or a large paraesophageal hernia was the indication for surgery.


METHODS
From a prospectively maintained clinical database of patients undergoing laparoscopic antireflux surgery, all patients aged 70 years or older were identified and their outcome was determined.


RESULTS
Two hundred ten patients were identified. In 129 a large paraesophageal hiatus hernia was the primary indication for surgery, and in 81 patients the indication was reflux. Mean operation time was significantly longer in patients undergoing surgery for a large hiatus hernia (109 vs. 72 min), and conversion to open surgery was required more often (11.6% vs. 4.4%), compared to patients with reflux alone. Follow-up information was available for 95% of patients. Postoperative symptom scores for heartburn and dysphagia improved significantly and patients' satisfaction with surgery was high.


CONCLUSIONS
Laparoscopic antireflux surgery in patients aged 70 years or older has a satisfactory clinical outcome. Elderly patients should not be refused laparoscopic antireflux surgery only because of their age.
Grotenhuis
Brechtje A
BA
Department of Surgery, Flinders University, Room 3D211, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia. bagrotenhuis@hotmail.com
Wijnhoven
Bas P L
BP
Bessell
Justin R
JR
Watson
David I
DI
D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006356:Heartburn / Q000209:etiology / Q000503:physiopathology; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome