Background

Minimally invasive antireflux surgery has been shown to be safe and effective for the treatment of gastroesophageal reflux (GERD) in elderly patients. However, there is a paucity of data on the influence of advanced age on long-term quality of life (QoL) and perioperative outcomes after laparoscopic antireflux surgery (LARS).

Method

A retrospective study of patients undergoing LARS between February 2012 and June 2018 at a single institution was conducted. Patients were divided into four age categories. Perioperative data and quality of life (QOL) outcomes were collected and analyzed.

Results

A total of 492 patients, with mean follow-up of 21 months post surgery, were included in the final analysis. Patients were divided into four age-determined subgroups (< 50:75, 50–65:179, 65–75:144, ≥ 75:94). Advancing age was associated with increasing likelihood of comorbid disease. Older patients were significantly more likely to require Collis gastroplasty (OR 2.09), or concurrent gastropexy (OR 3.20). Older surgical patients also demonstrated increased operative time (ß 6.29, p < .001), length of hospital stay (ß 0.56, p < .001) in addition to increased likelihood of intraoperative complications (OR 2.94, p = .003) and reoperations (OR 2.36, p < .05). However, postoperative QoL outcomes and complication rates were parallel among all age groups.

Conclusions

Among older patients, there is a greater risk of intraoperative complications, reoperation rates as well as longer operative time and LOS after LARS. However, a long-term QoL benefit is demonstrated among elderly patients who have undergone this procedure. Rather than serving as an exclusion criterion for surgical intervention, advanced age among chronic reflux patients should instead represent a comorbidity addressed in the planning stages of LARS.

中文翻译：

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腹腔镜裂孔疝修补术中与年龄有关的结果：抗返流手术是否“过老”？

背景

微创抗反流手术已被证明对老年患者的胃食管反流（GERD）治疗是安全有效的。但是，关于高龄对腹腔镜抗反流手术（LARS）后长期生活质量（QoL）和围手术期结局的影响的数据很少。

方法

回顾性研究了2012年2月至2018年6月期间在单一机构接受LARS的患者。患者分为四个年龄段。收集并分析围手术期数据和生活质量（QOL）结果。

结果

最终分析共纳入492例患者，平均术后21个月进行随访。将患者分为四个年龄分组（<50：75、50–65：179、65–75：144，≥75:94）。年龄的增长与合并症的可能性增加有关。年龄较大的患者更有可能需要进行Collis胃成形术（OR 2.09）或同时进行腹腔镜手术（OR 3.20）。旧版手术患者也表现出增加的手术时间（SS 6.29，p  <0.001）住院，长度（SS 0.56，p  <0.001）除了增加术中并发症的可能性（OR 2.94，p  = 0.003）和再手术（或2.36，第 <.05）。然而，所有年龄组的术后QoL结果和并发症发生率均平行。

结论

在老年患者中，LARS发生术中并发症，再次手术率更高，手术时间更长和LOS的风险更高。但是，在接受该手术的老年患者中证明了长期的QoL益处。慢性反流患者的高龄并非代表手术干预的排除标准，而应代表在LARS计划阶段中解决的合并症。