Background

It is anticipated that surgical treatment for gastro-esophageal reflux disease (GERD) in the elderly will increase. This time, using propensity score matching, we examined the results of laparoscopic fundoplication (LF) for GERD-related diseases in the elderly.

Methods

Of 302 cases which underwent initial LF for GERD-related diseases during the period from June 2008 to February 2019, we classified them into elderly (65 years of age or older) and non-elderly groups (64 years of age or younger). 57 cases each were extracted upon performing propensity score matching regarding five factors including: gender; body mass index; esophageal hiatal hernia; extent of reflux esophagitis; and the use of mesh.

Results

With regard to the preoperative disease status, the pH < 4 holding time was indicated as 2.8% (0.5–10.7%) in the elderly group and 3.4% (0.6–8.0%) in the non-elderly group, with no difference in terms of the illness period as well (p = 0.889 and p = 0.263, respectively). Although there was no difference in terms of the operative time (155 vs. 139 min, p = 0.092) and estimated blood loss (both ≒ 0 ml, p = 0.298), postoperative hospital stay was prolonged in the elderly group [7 (7–9) vs. 7 (7–7), p = 0.007]. On the other hand, esophageal hiatal hernia, reflux esophagitis, and acid reflux time in the esophagus were all improved following surgery in both groups (p < 0.001 in both groups).

Conclusion

The treatment results of LF for GERD-related diseases in the elderly were as good as those in the non-elderly, indicating possible safe implementation.

中文翻译：

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腹腔镜胃底折叠术治疗老年GERD相关疾病的疗效观察

背景

预计老年人胃食管反流病（GERD）的手术治疗将会增加。这一次，我们使用倾向评分匹配，检查了老年 GERD 相关疾病的腹腔镜胃底折叠术 (LF) 的结果。

方法

在 2008 年 6 月至 2019 年 2 月期间因 GERD 相关疾病接受初始 LF 的 302 例病例中，我们将其分为老年人（65 岁或以上）和非老年人组（64 岁或以下）。对包括性别在内的五个因素进行倾向评分匹配后，分别提取了 57 个案例。体重指数；食管裂孔疝；反流性食管炎的程度；以及网格的使用。

结果

术前疾病状态方面，老年组pH < 4保持时间为2.8%（0.5-10.7%），非老年组为3.4%（0.6-8.0%），无差异病期的时间（分别为p =  0.889 和p =  0.263）。虽然在手术时间（155 对 139 分钟，p =  0.092）和估计失血量（均≒ 0 ml，p =  0.298）方面没有差异，但老年组的术后住院时间延长了 [7 (7 –9) 与 7 (7–7)，p =  0.007]。另一方面，术后两组食管裂孔疝、反流性食管炎和食管反酸时间均得到改善（p 两组均 < 0.001）。

结论

LF对老年人GERD相关疾病的治疗效果与非老年人一样好，表明可以安全实施。