Is laparoscopic antireflux surgery for gastroesophageal reflux disease in the elderly safe and effective?

The elderly have prevalence rates and clinical features of gastroesophageal reflux disease (GERD) similar to those in younger individuals, but the role of laparoscopic antireflux surgery (LARS) in the elderly has not been clearly established. The purpose of this study was to determine if the results of LARS in the elderly are comparable with those in younger patients.

All patients undergoing LARS for GERD at the Washington University Medical Center were entered prospectively into a computerized database. Between May 1992 and June 1998, 339 patients underwent LARS and were divided into two groups based on age: nonelderly (ages, 18-64 years; n = 303) and elderly (age, >/=65 years; n = 36). Data were expressed as mean +/- standard deviation (SD) and statistical analysis was performed.

Elderly patients had a higher American Society of Anesthesiology (ASA) score (2.3 +/- 1.5) and a longer hospital stay (2.1 +/- 0.2 days) than the younger group (ASA, 1.9 +/- 0.5; hospital stay, 1.6 +/- 0.9 days; p < 0.001). Operation times averaged 154 +/- 68 min in the elderly compared with 134 +/- 49 min in the nonelderly (p = NS). Grade I complications occurred significantly more frequently in the elderly (13.9%) than in the nonelderly (2.6%), but the incidence of grade II complications was similar between the groups (elderly 2.8% vs nonelderly 2.7%). There were no grade III complications in either group, but there was one death in the nonelderly group. At follow-up ranging to 81 months (median, 27 months), the two groups had similar low incidences of heartburn and dysphagia. Anatomic failures of LARS developed in 19 nonelderly patients (6.2%) compared with 2 elderly patients (5.5%; p = NS).

As shown in this study, LARS is safe and effective in elderly patients with GERD. Age older than 65 years should not be a contraindication to laparoscopic antireflux surgery in properly selected patients.