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This article is part of the supplement: Selected articles from the XXV National Congress of the Italian Society of Geriatric Surgery

Open Access Research article

GERD in elderly patients: surgical treatment with Nissen-Rossetti laparoscopic technique, outcome

Giovanni Aprea1*, Antonio Ferronetti1, Alfonso Canfora1, Fabrizio Cardin2, Antonio Giugliano1, Francesco Guida1, Antonio Braun1, Melania Battaglini Ciciriello1, Federica Tovecci1, Giovanni Mastrobuoni1 and Bruno Amato1

Author Affiliations

1 Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University “Federico II” of Naples, Via Pansini, 5 - 80131 – Naples, Italy

2 Department of Surgical and Gastroenterological Sciences, Padova University Hospital, Italy, Via Giustiniani n.2, 35126 Padova, Italy

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BMC Surgery 2012, 12(Suppl 1):S4  doi:10.1186/1471-2482-12-S1-S4

Published: 15 November 2012

Abstract

Background

The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. Surgical treatment is reserved to selected patients, affected by severe forms of disease and/or without compliance to medical therapy.

In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed.

Functional evaluations performed on pre and post – surgical pHmetric and manometric examination have provided new acquisitions about improvements in the restoration of anatomical and functional integrity of the esophagus-gastric antireflux barrier.

Methods

45 elderly patients with GERD were recruited in a 27 months period. All patients were subjected to laparoscopic Nissen-Rossetti 360° fundoplication. The subjects had a pre-surgical evaluation with:

• 24 hours pHmetry,

• esophageal manometry,

The same evaluation was repeated 1 month and 6 months after surgical intervention.

Results

In our series all patients get benefit from surgical treatment, with an improvement of pHmetric and manometric parameters and a regression of complications of GERD such as Barrett's metaplasia. In 8.33% of patients a PPI therapy was necessary, after the surgical intervention, to control symptoms.

Conclusions

The role of surgery in GERD concerns selected patients. Nissen-Rossetti mini-invasive approach is performed with an acceptable percentage of complications (3%-10%). This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric.