Results after laparoscopic fundoplication: does age matter?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Geriatric Medicine

Background:

• Antireflux fundoplications are often avoided in older adults due to concerns about increased morbidity and poorer outcomes.
• Gastroesophageal reflux disease (GERD) symptoms can significantly impact the quality of life in elderly individuals.

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic Nissen fundoplication in patients over 70 years old.
• To compare outcomes of fundoplication in elderly patients versus a younger control group.

Main Methods:

• A retrospective comparison of 108 patients aged 70-90 undergoing laparoscopic Nissen fundoplication with 108 patients aged 18-59.
• Patients self-reported reflux and dysphagia severity using a Likert Scale before and after surgery.
• Outcomes including symptom scores, complications, and patient satisfaction were analyzed.

Main Results:

• Complications were infrequent and not age-dependent, with one death from myocardial infarction in an 86-year-old patient.
• Both older and younger patients experienced significant improvements in reflux and dysphagia symptoms post-fundoplication (P < 0.01).
• Older patients reported excellent or good symptom relief (82%) and high willingness to repeat the procedure (91%), comparable to younger patients (81% and 85%, respectively).

Conclusions:

• Laparoscopic Nissen fundoplication is a safe and effective treatment for GERD in elderly patients.
• Elderly patients achieve significant symptom amelioration, with outcomes superior to younger counterparts in terms of reduced symptomatic dysphagia and reflux.
• The procedure offers substantial benefits for older adults, challenging previous hesitations regarding its use in this population.