Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

Table 1 Modified DeMeester scoring system

Symptoms	Score	Description
Dysphagia	0	None
	1	Occasional transient episodes
	2	Require liquids to clear
	3	Impaction requiring medical attention
Heartburn	0	None
	1	Occasional brief episodes
	2	Frequent episodes requiring medical treatment
	3	Interference with daily activities
Regurgitation	0	None
	1	Occasional episodes
	2	Predictable by posture
	3	Interference with daily activities

Table 2 Preoperative evaluation: data and ASA score in EG and YG

Demographics	EG (> 65 yr)	YG (< 65 yr)	P
Age (mean yr ± SD)	72.6 ± 2.1	48.2 ± 3.2	< 0.05
Male:Female	1:1.5	1:1.7	NS
ASA score	2.2 ± 0.43	1.82 ± 0.51	< 0.05
Weight (mean ± SD)	64.4 ± 5.1	65.3 ± 6.4	NS

Table 3 Incidence of pre-operative symptoms in EG and YG

Symptoms	EG (%)	YG (%)	P
Heartburn	44/65 (67.7 )	298/355 (83.9 )	< 0.05
Acid regurgitation	39/65 (60.0 )	277/355 (78.0 )	< 0.05
Solid food dysphagia	22/65 (33.8 )	27/355 (7.6 )	< 0.05
Chest pain	18/65 (27.7 )	51/355 (14.4 )	< 0.05
Respiratory complication (chronic cough, sleep apnoea, asthma, laryngitis)	27/65 (41.5 )	19/355 (5.4 )	< 0.05

Table 4 Severity of preoperative symptoms in EG and YG (mean ± SD)

Symptoms	EG	YG	P
Heartburn	1.7 ± 0.87	2.7 ± 0.74	< 0.05
Acid regurgitation	1.5 ± 0.96	2.3 ± 0.89	< 0.05
Solid food dysphagia	1.6 ± 0.76	0.5 ± 0.2	< 0.05
Chest pain	1.6 ± 0.82	1.5 ± 0.87	> 0.05
Respiratory complication (chronic cough, sleep apnoea, asthma, laryngitis)	1.8 ± 1.04	1.0 ± 0.45	< 0.05

Table 5 Preoperative manometric evaluation in EG and YG

Manometry	EG	YG	P
LES pressure (mmHg)	11.2 ± 1.5	11.0 ± 1.2	> 0.05
Impaired esophageal peristalsis (< 30 mmHg)	43/65 (66.2%)	114/355 (32.1%)	< 0.05
N° of patients

Table 6 Preoperative evaluation: incidence, size of HH and pH metric data in NERD, ERD and Barrett patients in EG and YG

	EG	YG	P	EG	YG	P	EG	YG	P
	NERD	NERD		ERD	ERD		Barrett	Barrett
Patients n (%)	15/65 (23.1)	220/355 (62)	< 0.05	45/65 (69.2)	125/355 (35.2)	< 0.05	5/65 (7.7)	10/355 (2.8)	< 0.05
Hiatal Hernia n (%)	13/15 (86.7)	148/220 (67.3)	< 0.05	39/45 (86.7)	97/125 (77.6)	< 0.05	4/5 (80)	8/10 (80)	-
Hiatal Hernia size (cm)	1.2 ± 0.18	0.3 ± 0.1	< 0.05	4.1 ± 1.9	2.3 ± 0.2	< 0.05
De Meester score	13.1 ± 1.2	12.4 ± 1.2	> 0.05	17.5 ± 1.4	14.3 ± 1.2	> 0.05	18.2 ± 1.3	16.2 ± 1.4	> 0.05
(%) time pH < 4 (total)	11 ± 3	6 ± 2	< 0.05	26 ± 3	11 ± 5	< 0.05	27 ± 6	27 ± 5	> 0.05
(%) time pH < 4 (supine)	12 ± 4	7 ± 2	< 0.05	28 ± 4	13 ± 4	< 0.05	29 ± 5	30 ± 8	> 0.05
(%) time pH < 4 (upright)	9 ± 4	5 ± 2	< 0.05	15 ± 5	5 ± 3	< 0.05	25 ± 2	22 ± 7	> 0.05

Table 7 Perioperative results in EG and YG

Intraoperative results	EG	YG	P
Operative time (m)	61 ± 15	45 ± 15	< 0.05
Operative blood loss (mL)	50 (0-120)	30 (0-100)	< 0.05
Major complications	0	4/355 (1.1%)1	-
Mortality	0	0	-
Postoperative recovery
Post operative hospital stay (d)	3.8 ± 1.0	2.4 ± 0.9	< 0.05
Resumption of normal activity (d)	12.5 ± 9.0	8.3 ± 3.4	< 0.05

¹ 1/335 intraoperative mucosal tear, 3/335 postoperative bleeding (1 splenectomy).

Table 8 Postoperative symptoms score in EG and YG (mean symptom score ± SD)

Symptoms	EG		P	YG		P
	Preop.	Postop.		Preop.	Postop.
Heartburn	1.7 ± 0.87	0.2 ± 0.12	< 0.05	2.7 ± 0.74	0.3 ± 0.11	< 0.05
Acid regurgitation	1.5 ± 0.96	0.3 ± 0.13	< 0.05	2.3 ± 0.89	0.2 ± 0.12	< 0.05
Solid food dysphagia	1.6 ± 0.76	0.4 ± 0.12	< 0.05	0.5 ± 0.2	0.2 ± 0.15	< 0.05
Chest pain	1.6 ± 0.82	0.3 ± 0.21	< 0.05	1.5 ± 0.87	0.2 ± 0.13	< 0.05
Respiratory complication	1.8 ± 1.04	0.3 ± 0.11	< 0.05	1.0 ± 0.45	0.2 ± 0.12	< 0.05
(chronic cough, sleep apnoea, asthma, laryngitis)

Preop: preoperative; Postop: postoperative.

Table 9 Postoperative side effects in EG and YG

	EG	YG	P
Postoperative side effects: number patients (%)
Dysphagia	2/62 (3.2%)1	11/338 (3.3%)2	> 0.05
Heartburn	2/62 (3.2%)3	12/338 (3.6%)4	> 0.05
Hyperflautolence	1/62 (1.6%)	6/338 (1.8%)	> 0.05
Early satiety	2/62 (3.2%)	9/338 (2.7%)	> 0.05
Bloating	1/62 (1.6%)	3/338 (0.9%)	> 0.05
Chest pain	0	2/338 (0.6%)	> 0.05

¹ 2 dilation;

² 5 dilation, 6 laparoscopic re-fundoplication;

³ 2 reassumed peptic medications;

⁴ 8 reassumed peptic medications, 4 laparoscopic re-fundoplication.

Table 10 Postoperative manometric evaluation at 24 mo after surgery in EG and YG

Manometry	EG (36 Pts)		P	YG (230 Pts)		P
	Preop.	Postop.		Preop.	Postop.
N-HPZ pressure (mmHg)	11.2 ± 1.5	28.2 ± 1.5	< 0.05	11.0 ± 1.2	28.1 ± 1.2	< 0.05
Increase of mean		28/36			100/230
peristalsis waves patients n (%)		(77.8%)			(43.5%)

Preop: preoperative; Postop: postoperative.

Table 11 De Meester score and percentage of reflux time during 24 h in EG and YG, preoperative and 1 yr after surgery

	Preoperative	1 yr after surgery
DeMeester score
EG	15.1 ± 1.1	1.2 ± 0.7
YG	13.4 ± 1.5	1.1 ± 0.2
(%) time pH < 4
EG	9.1 ± 0.6	1.4 ± 0.3
YG	8.2 ± 0.7	0.9 ± 0.8