Researchers evaluated the surgical outcome, including quality of life, after laparoscopic antireflux surgery (LARS) in gastroesophageal reflux disease (GERD) patients older than 65 years.
Since 1993, more than 500 patients underwent LARS in the researchers' institute. A total of 72 patients, older than 65 years, had been treated with laparoscopic 'floppy' Nissen (n= 51) or Toupet (n= 21) fundoplication.
The patients included 23 women and 49 men, with a mean age of 71 years.
Quality of life was evaluated using the ‘Gastrointestinal Quality of Life Index' (GIQLI). The GIQLI was evaluated prior to surgery and after surgery, and at 3 months and 1 year, with 24-hour pH monitoring and esophageal manometry being performed.
The team found that intraoperative complications occurred in 2 patients, which were successfully managed laparoscopically. Conversion to laparotomy and mortality were 0%.
Postoperative complications occurred twice: one patient had a perianal thrombosis; one had an epileptic seizure.
|Quality of life increased significantly following laparoscopic antireflux surgery.
|Scandanavian Journal of Gastroenterology
At 3 months, and at 1 year after surgery, 24-hour pH monitoring and esophageal manometry showed normal values in all patients.
GIQLI increased significantly (mean preoperative, 86 points; 3 months, 120.1 points; 1 year, 119.3 points) after surgery, and was comparable to healthy individuals (118.7 points).
One patient suffered from severe dysphagia and required dilatation. In two patients, laparoscopic refundoplication was necessary one year after the initial procedure because of a 'slipping Nissen' and a 'telescope phenomenon'. Three years after, LARS data were comparable to 1 year after surgery.
Researcher T. Kamolz concluded on behalf of the group, "As our data show, LARS can be a safe and effective procedure that significantly improves quality of life in the elderly patient suffering from GERD.
"Age should no longer be a contraindication to LARS."