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ROBOTIC FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX DISEASE AND HIATAL HERNIA IN ELDERLY
Massimo Arcerito*, John T. Moon Surgery, University of California Irvine, Riverside, CA Introduction. Gastroesophageal Reflux Disease (GERD) represents an epidemic presentation in clinical practice. Minimally invasive surgery is well established in younger patients in whom long term medical treatment is mandatory to achieve symptomatic control and to avoid complications of this common disease. Furthermore, it is still unclear if advanced age should be considered as a limiting factor in surgically treating GERD and hiatal hernia, or if fundoplication in elderly patients is as safe and effective as in younger individuals. Hypothesis. We hypothesized that the safety and outcome of robotic fundoplication in patients less than 65 years old is comparable with patients of 65 years old or older. Material and Methods. Between March 2014 and June 2017, 90 consecutive patients underwent robotic fundoplication for treatment of GERD and hiatal hernia. Fifty patients (Group A) were younger than 65 years old (median age 53) and fourty patients (group B) were 65 years old or older (median age 73). Presence, duration and severity of symptoms (heartburn, regurgitation, dysphagia, shortness of breath, cough), preoperative esophageal function tests results, type of hiatal hernia, preoperative esophageal stricture were the main outcome before surgery. In addition, emergent surgery, operative time, intra- and perioeperative complications, hospital stay, short and long clinical outcome and postoperative dysphagia represented main postoperative outcome measures in our study. Results. Both groups were similar. Group B had longer duration of symptoms, severe respiratory symptomatology and regurgitation, larger hiatal hernias and more emergent surgery compared with Group A. Operative time differed for larger hiatal hernias, but it was otherwise comparable among younger and elderly patients. In a subset of elderly patients, postoperative dysphagia lasted longer compared with younger patients. No esophageal dilation was necessary. No statistical significance was found among all the remained main outcome measures in both groups including excellent postoperative outcome. Conclusions. Age should not be a considered limiting factor in treating GERD and hiatal hernia. Robotic fundoplication is safe and achievable in elderly with comparable measures to younger patients. We speculate that earlier surgical treatment of hiatal hernia might reduce the incidence of larger size, regurgitation, respiratory symptomatology and emergent surgery in elderly population.
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