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Short- and long-term results after laparoscopic floppy Nissen fundoplication in elderly versus non-elderly patients


1 Department of Surgery, University of L'Aquila, L'Aquila, Italy
2 Department of Surgery, Hospital SS. Trinità, Sora, Italy

Date of Submission13-Oct-2018
Date of Acceptance18-Feb-2019
Date of Web Publication24-Apr-2019

Correspondence Address:
Lucia Romano,
Department of Surgery, University of L'Aquila, L'Aquila, 67100 Coppito (AQ),
Italy
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmas.JMAS_269_18

PMID: 31031314

  Abstract 

Background: Laparoscopic anti-reflux surgery could be of benefit in a subset of elderly patients with gastroesophageal reflux disease. However, there are few reports that have evaluated the long-term results. This study examined the effects of age on the short- and long-term (for at least 5 years) outcomes after laparoscopic Nissen fundoplication (LNF).
Patients and Methods: Patients were divided into four groups as follows: young (18–49); adult (50–69); and elderly (70–84), and very elderly (85–91). The database (recorded prospectively) included operating duration, conversion, intra- and early post-operative complication and late outcomes. Mean follow-up was 14.5 years (range 5–24 years).
Results: Five hundred and sixty-nine patients met the inclusion criteria: young n = 219 (38.4%); adult n = 248 (43.5%); elderly n = 91 (16.0%) and very elderly n = 11 (1.9%). Hiatal hernia (type I and III) was significantly less frequent in young and adult patients (P < 0.0001). The operation was significantly longer in elderly and very elderly patients (P < 0.001); the use of drains (P < 0.001) and grafts (P < 0.0001) for hiatal hernia repair was less in young and adult patients. The hospital stay, conversion (5.4%), intra-operative and early post-operative complications were not influenced by age. Dysphagia was evenly distributed among the groups. Forty-eight (8.4%) patients had recurrence: 15 in the young group (6.8%), 18 in the adult group (7.2%), 11 in the elderly group (12%) and 4 in the very elderly group (36.3%) (P < 0.0001).
Conclusions: Age does not influence short- and long-term outcomes following LNF. Control of reflux in the elderly is worse than adult patients. Therefore, ageing is a relative contraindication to LNF.


Keywords: Elderly, follow-up, gastroesophageal reflux disease, laparoscopic Nissen fundoplication



How to cite this URL:
Schietroma M, Colozzi S, Romano L, Pessia B, Giuliani A, Vicentini V, Recchia CL, Carlei F. Short- and long-term results after laparoscopic floppy Nissen fundoplication in elderly versus non-elderly patients. J Min Access Surg [Epub ahead of print] [cited 2021 Dec 9]. Available from: https://www.journalofmas.com/preprintarticle.asp?id=256949


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2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04