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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.
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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)