Background: Historically, elderly and infirm patients have received nonoperative therapy for the treatment of achalasia and other primary motor disorders of the esophagus. We reviewed our experience with laparocopic Heller myotomy (LHM) in the aged.
Methods: From a prospectively collected database of over 1000 patients undergoing laparoscopic foregut surgery between 10/91 and 10/00, 21 patients aged 63 or older (63-88 yrs)underwent a LHM. This group was evaluated for length of hospital stay (LOS), duration of surgery (DOS), ASA class, perioperative complications (PC), and operative mortality (OM). Symptom scores for regurgitation (REG), dysphagia (DYS), chest pain (CP), and heartburn (HB) were evaluated pre- and post-operatively. Follow-up was by survey and physician visit. Results for agea, ASAl, DOSa, PCf, and OMf were compared to previously published data from our institution1. (Wilcoxson Signed Ranks test, aStudent's t-test, lMann-Whitney test, fX2 test).
Results: Results are displayed in the table (mean ± SEM). The elderly group had a significantly higher ASA class, p<0.001. DOS, PC, and LOS were not significantly different from our previous study. Postopeartively, DYS and REG scores improved significantly, p<0.004 and p<0.002 respectively. However, there was no change in the scores for CP or HB.
Conclusions: LHM with fundoplication is a safe and effective procedure for older patients who have traditionally been felt to be best managed non-operatively. LHM should not be withheld based on advanced age. 1Ann Surg 1997;225:655-665.
LHM - Elderly LHM 19971
N 21 33
Age (years) 72 ± 1.5* 34 ± 2.7
ASA (median) 3* 2
DOS (mins) 198 ± 47 199 ± 36
LOS (days) 2.6 2.8
PC (%) 10.5 7.5
OM (%) 0 0