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Pietro Tedesco, MD; Errol Lobo, MD; Piero M. Fisichella, MD; Lawrence W. Way, MD; Marco G. Patti, MD

Arch Surg. 2006;141:289-292.

Hypothesis  It is unclear if age should be considered a factor in the choice of treatment for gastroesophageal reflux disease (GERD) and if fundoplication in elderly patients is as safe and effective as it is in younger patients. We hypothesized that the outcome of laparoscopic antireflux operations in patients younger than 65 years is similar to that of patients 65 years and older.

Design  Retrospective review of findings from a prospectively acquired database.

Setting  University-based tertiary care center.

Patients  Three hundred four consecutive patients underwent laparoscopic fundoplication for GERD. Two hundred forty-one patients were younger than 65 years (group A; median age, 46 years), and 63 patients were 65 years or older (group B; median age, 69 years).

Main Outcome Measures  Presence, duration, and severity of GERD symptoms; presence of a hiatal hernia or esophageal stricture; duration of operation; incidence of complications; and length of hospital stay.

Results  Elderly patients more often had regurgitation and respiratory symptoms in addition to heartburn. Hiatal hernias were more common among elderly patients (77% vs 51%). The duration of the operation was similar for the 2 groups. The incidence of intraoperative and postoperative complications was low and similar in the 2 groups. The median hospital stay was 24 hours for each group. Heartburn resolved in approximately 90% of patients in each group.

Conclusions  Elderly patients more often had hiatal hernias and respiratory symptoms. Laparoscopic antireflux surgery was as safe in elderly patients as it was in younger patients, and clinical outcomes were as good.

Author Affiliations: Departments of Surgery (Drs Tedesco, Fisichella, Way, and Patti) and Anesthesia (Dr Lobo), University of California, San Francisco.

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Laparoscopic Fundoplication in Elderly Patients With Gastroesophageal Reflux Disease--Invited Critique
Buyske
Arch Surg 2006;141:292-292.
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