Long term quality of life after laparoscopic antireflux surgery for the elderly

BMC Surgery, Oct 2013

Background Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. Methods Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. Results Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). There were 114 (36.6%) patients who filled out the SF36 questionnaire (98 in the younger group, rate: 37.4%; 16 in the elderly group, rate: 32.6%) pre- and post-operatively. There was no significant difference between the two age groups regarding preoperative PCS ( 45.6 ± 7.8 in YG vs. 44.2 ± 8.2 in EG; P = 0.51) and MCS ( 48.1 ± 10.7 in YG vs. 46.9 ± 9.2 in EG; P = 0.67). There was no significant difference between the two age groups regarding postoperative PCS (49.8 ± 11.9 in YG and 48.2 ± 9.5 in EG ; P = 0.61 and MCS (48.4 ± 10.7 in YG vs. 50.1 ± 6.9 in EG; P = 0.54). Conclusions In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly.

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Long term quality of life after laparoscopic antireflux surgery for the elderly

Tolone et al. BMC Surgery Long term quality of life after laparoscopic antireflux surgery for the elderly Salvatore Tolone 0 Giovanni Docimo 0 Gianmattia Del Genio 0 Luigi Brusciano 0 Ignazio Verde 0 Simona Gili 0 Chiara Vitiello 0 Antonio D'Alessandro 0 Giuseppina Casalino 0 Francesco Saverio Lucido 0 Nicola Leone 0 Raffaele Pirozzi 0 Roberto Ruggiero 0 Ludovico Docimo 0 0 Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples , Via S. Pansini 5, 80131, Naples , Italy Background: Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. Methods: Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. Results: Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). There were 114 (36.6%) patients who filled out the SF36 questionnaire (98 in the younger group, rate: 37.4%; 16 in the elderly group, rate: 32.6%) pre- and post-operatively. There was no significant difference between the two age groups regarding preoperative PCS ( 45.6 7.8 in YG vs. 44.2 8.2 in EG; P = 0.51) and MCS ( 48.1 10.7 in YG vs. 46.9 9.2 in EG; P = 0.67). There was no significant difference between the two age groups regarding postoperative PCS (49.8 11.9 in YG and 48.2 9.5 in EG ; P = 0.61 and MCS (48.4 10.7 in YG vs. 50.1 6.9 in EG; P = 0.54). Conclusions: In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly. - From 26th National Congress of the Italian Society of Geriatric Surgery Naples, Italy. 19-22 June 2013 Background Gastroesophageal reflux disease is a frequent chronic disease related to retrograde flow of gastroduodenal contents into the esophagus [1]. As long-term therapeutic strategies for chronic gastro-esophageal reflux disease (GERD), surgery and Proton-pump inhibitors are effective and well tolerated, with antireflux surgery being superior in controlling overall disease manifestations [2]. Only 20 years have passed since the introduction of the first laparoscopic cholecystectomy and its general acceptance as the standard treatment for patients with benign and malignant disease [3-7]. Since then, a great number of different surgical procedures has been carried out via laparoscopy [8-11] Laparoscopic surgery for GERD carries significant advantages in terms of lower overall morbidity, shorter postoperative hospital stay, and faster return to normal physical activity [12]. The measurement of quality of life ( QoL) is of paramount importance when attempting to compare outcomes after treatments, because neither questioning the patient about symptoms nor the assessment of objective instrumental testing seem to adequately provide an adequate assessment of patients subjective wellbeing [13]. Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients [14,15]. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. Methods A prospective electronic database of all patients admitted for GERD in our university medical center (Division of General Surgery, Second University of Naples, Naples, Italy), was reviewed. Demographic data were obtained at the time of first visit. Patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining as the young group (YG). The study protocol was approved previously by the Ethical Committee of the Second University of Naples. All patients and controls were Caucasians from Italy. Patients having typical or atypical symptoms for at least 6 months and requiring daily medical therapy for symptom control were offered the alternative of continuing with medical therapy or undergoing antireflux surgery. Patients who had undergone previous antireflux surgery or who required a concurrent abdominal procedure at the same time as fundoplication (eg, cholecystectomy), as well as patients with Barretts esophagus, were excluded from this study. All patients underwent a scheduled work-up that included upper- gastro (...truncated)


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Salvatore Tolone, Giovanni Docimo, Gianmattia Del Genio, Luigi Brusciano, Ignazio Verde, Simona Gili, Chiara Vitiello, Antonio D'Alessandro, Giuseppina Casalino, Francesco Lucido, Nicola Leone, Raffaele Pirozzi, Roberto Ruggiero, Ludovico Docimo. Long term quality of life after laparoscopic antireflux surgery for the elderly, BMC Surgery, 2013, pp. S10, 13, DOI: 10.1186/1471-2482-13-S2-S10