title: GERD in elderly patients: surgical treatment with Nissen-Rossetti laparoscopic technique, outcome.
abstract: BACKGROUND
  The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. Surgical treatment is reserved to selected patients, affected by severe forms of disease and/or without compliance to medical therapy.In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed.Functional evaluations performed on pre and post--surgical pHmetric and manometric examination have provided new acquisitions about improvements in the restoration of anatomical and functional integrity of the esophagus-gastric antireflux barrier.
  
  
  METHODS
  45 elderly patients with GERD were recruited in a 27 months period. All patients were subjected to laparoscopic Nissen-Rossetti 360° fundoplication. The subjects had a pre-surgical evaluation with:• 24 hours pHmetry,• esophageal manometry,The same evaluation was repeated 1 month and 6 months after surgical intervention.
  
  
  RESULTS
  In our series all patients get benefit from surgical treatment, with an improvement of pHmetric and manometric parameters and a regression of complications of GERD such as Barrett's metaplasia. In 8.33% of patients a PPI therapy was necessary, after the surgical intervention, to control symptoms.
  
  
  CONCLUSIONS
  The role of surgery in GERD concerns selected patients. Nissen-Rossetti mini-invasive approach is performed with an acceptable percentage of complications (3%-10%). This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric.
authors.affiliation: Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University Federico II of Naples, Via Pansini 5, 80131 Naples, Italy. giovanni.aprea@yahoo.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aprea
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferronetti
authors.forename: Alfonso
authors.initials: A
authors.lastname: Canfora
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cardin
authors.forename: Antonio
authors.initials: A
authors.lastname: Giugliano
authors.forename: Francesco
authors.initials: F
authors.lastname: Guida
authors.forename: Antonio
authors.initials: A
authors.lastname: Braun
authors.forename: Melania
authors.initials: M
authors.lastname: Battaglini Ciciriello
authors.forename: Federica
authors.initials: F
authors.lastname: Tovecci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mastrobuoni
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D011446:Prospective Studies; D016896:Treatment Outcome