Department of Surgery, Division of Endocrine and Minimally Invasive Surgery, Weill Cornell Medicine, 525 E 68th Street, 1300 York Avenue, New York, NY, 10065, USA.
Surg Endosc. 2024 Sep;38(9):5285-5291. doi: 10.1007/s00464-024-11037-w. Epub 2024 Jul 15.
As our population ages, older adults are being considered for anti-reflux surgery (ARS). Geriatric patients typically have heightened surgical risk, and literature has shown mixed results regarding postoperative outcomes. We sought to evaluate the safety and efficacy of robotic ARS in the geriatric population.
We conducted a single-institution review of ARS procedures performed between 2009 and 2023. Patients ≥ 65 were assigned to the geriatric cohort. We compared operative details, lengths of stay (LOS), readmissions, reoperations, and complications between the two cohorts. The gastroesophageal reflux disease health-related quality of life (GERD-HRQL) survey and review of clinic notes were used to evaluate ARS efficacy.
628 patients were included, with 190 in the geriatric cohort. This cohort had a higher frequency of diabetes (16.3% vs 5.9% p < 0.0001), hypertension (50.0% vs 21.5% p < 0.0001), and heart disease (17.9% vs 2.3% p < 0.0001). Geriatric patients were more likely to exhibit hiatal hernias on imaging (51.6% vs 34.2% p < 0.0001) and were more likely to have large hernias (30.0% vs 7.1% p < 0.0001). Older adults were more likely to undergo Toupet fundoplications (58.4% vs 41.3%, p < 0.0001), Collis gastroplasties (9.5% vs 2.7% p < 0.0001), and relaxing incisions (11.6% vs 1.4% p < 0.0001). Operative time was longer for geriatric patients (132.0 min vs 104.5 min p < 0.0001). There were no significant differences in LOS, readmissions, or reoperations between cohorts. Geriatric patients exhibited lower rates of complications (7.4% vs. 14.6%, p = 0.011), but similar complication grades. Both groups had significant reduction in symptom scores from preoperative values. There were no significant differences in the reported symptoms between cohorts at any follow-up timepoint.
Geriatric robotic ARS patients tend to do as well as younger adults regarding postoperative and symptomatic outcomes, despite presenting with larger hiatal hernias and shorter esophagi. Clinicians should be aware of possible need for lengthening procedures or relaxing incisions in this population.
随着人口老龄化，老年人开始考虑接受抗反流手术（ARS）。老年患者通常具有更高的手术风险，并且文献中关于术后结果的结果喜忧参半。我们旨在评估机器人 ARS 在老年人群中的安全性和有效性。
我们对 2009 年至 2023 年期间进行的 ARS 手术进行了单机构回顾。≥65 岁的患者被分配到老年组。我们比较了两组之间的手术细节、住院时间（LOS）、再入院、再次手术和并发症。使用胃食管反流病健康相关生活质量（GERD-HRQL）调查和临床记录回顾来评估 ARS 疗效。
共纳入 628 例患者，其中 190 例为老年组。该队列中糖尿病（16.3%比 5.9%，p<0.0001）、高血压（50.0%比 21.5%，p<0.0001）和心脏病（17.9%比 2.3%，p<0.0001）的发生率更高。老年患者在影像学上更有可能出现食管裂孔疝（51.6%比 34.2%，p<0.0001），并且更有可能出现大疝（30.0%比 7.1%，p<0.0001）。老年人更有可能接受 Toupet 胃底折叠术（58.4%比 41.3%，p<0.0001）、Collis 胃底折叠术（9.5%比 2.7%，p<0.0001）和松弛切口（11.6%比 1.4%，p<0.0001）。老年患者的手术时间更长（132.0 分钟比 104.5 分钟，p<0.0001）。两组之间 LOS、再入院或再次手术无显着差异。老年患者的并发症发生率较低（7.4%比 14.6%，p=0.011），但并发症等级相似。两组患者的症状评分均从术前值显着降低。在任何随访时间点，两组报告的症状均无显着差异。
尽管老年机器人 ARS 患者的食管裂孔疝较大且食管较短，但与年轻患者相比，术后和症状结果相似。临床医生应意识到在该人群中可能需要延长手术或松弛切口。
