Postoperative recurrence factors of GERD in the elderly after laparoscopic fundoplication
Tóm tắt
Assessment of the outcomes of laparoscopic fundoplication in elderly patients with gastroesophageal reflux disease (GERD) is insufficient. Of the 256 patients with GERD who underwent surgery between December 1994 and December 2008, sufficient postoperative follow-up was completed in 205 patients. Of the 205 patients who were included in the study, 166 were younger than 70 years of age (mean, 49.2 ± 14.1 years; 108 men/58 women), and 39 patients were 70 years or older (mean, 74.8 ± 4.3 years; 11 men/28 women). Preoperative clinical conditions were assessed using the AFP classification. Recurrence was defined as postoperative recurrence of erosive esophagitis or evident hiatus hernia. Clinical conditions of cases with and without recurrence were compared to identify factors associated with the recurrence. Statistical analyses were performed using the Mann-Whitney U test. Five cases (13%) in the elderly patient group were judged to have a recurrence, all of whom had recurrent esophagitis and hernia. There was a significant difference in surgical procedures (P = 0.005) between the recurrence and nonrecurrence groups. There were 17 (10%) recurrent cases in the nonelderly patient group. In a comparison of the recurrence and nonrecurrence groups, there were signifi cant differences in age (P = 0.002), duration of symptoms (P = 0.029), A factor (P = 0.004), and AFP score (P = 0.007), but not in the surgical procedures. The risk factors for recurrence were different between nonelderly patients and elderly patients. The laparoscopic Collis-Nissen methods should be indicated with caution in elderly GERD patients with a short esophagus.
Tài liệu tham khảo
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