Outcomes of minimally invasive antireflux operations in the elderly: a comparative review

The objectives of this study were to assess the impact of age following laparoscopic fundoplication (LF).

From March 1993 to November 1998, 193 patients underwent LF. Patients comprised 150 young individuals (age<60; median 41) and 43 older individuals (age>60; median 68). Follow-up included heartburn scores, dysphagia scores, and quality of life determined by the Short Form 36 Health Survey (SF36).

Older patients had more cardiac disease, psychiatric disorders, prior cancers, and upper abdominal operations (P<0.05). DeMeester scores were similar (young 70/older 69). Complications occurred in 13 (8.7%) of the young and 5 (11.6%) of the older patients (P=0.142). No perioperative deaths occurred. Length of stay was longer (P<0.000) in older patients (2.9 versus 1.6 days); resumption of oral intake (young-1.2; older-1.3 days) and return to normal activity (young-3.6; older-4.4 weeks) were similar. Follow-up was available in 102 young (median 17 months) and 35 older (median 18 months) patients. Heartburn and dysphagia scores were excellent in both groups. SF36 scores were similar in both groups. Only 6 (5.9%) of the young group and 1 (2.9%) of the older group were dissatisfied (P=0.652).

Despite differences in comorbid disease, outcomes were similar in both groups. LF should be considered a therapeutic option in the older patient with reflux.