TAILORED ANTIREFLUX SURGERY

Background: With increasing age, the functional condition of the lower esophageal sphincter is getting weaker. Recent progress in peri-operative intensive care and the development of laparoscopic technique makes antireflux surgery a safe choice of GERD treatment in the elderly. Aim: This work evaluated the long-term results of tailored antireflux surgery in a group of elderly (more than 60 years old) patients. Results: Five hundred and eighty one patients underwent antireflux surgery in our department from 1999 to 2005. Seventy of them (12,0%) were older than 60 years. Exclusion criteria of surgery were ASA IV classification and high grade esophageal dysmotility. Toupet’s wrap was offered to patients with esophageal dysmotility or esophageal sphincter pressure higher than 15mm Hg (16 cases). The rest were offered Nissen-Rossetti’s complete wrap (54 cases). There was zero mortality and no further significant dysphagia. Pathological gastro-esophageal reflux after the surgery was detected in 6 patients (8,6%), which was a higher proportion than in the group of patients under 60 years. Conclusion: Good results of antireflux surgery with zero mortality and low morbidity can be achieved even in the elderly (more frequent use of incomplete Toupet’s wrap).