Invited Critique |

Laparoscopic Fundoplication in Elderly Patients With Gastroesophageal Reflux Disease—Invited Critique

Jo Buyske, MD
Arch Surg. 2006;141(3):292. doi:10.1001/archsurg.141.3.292.
Text Size: A A A
Published online


Tedesco et al1 put forward a cogent argument for offering laparoscopic antireflux surgery to patients regardless of age. Their retrospective review of their own large database reveals some interesting and pertinent trends, including the finding that elderly patients (defined as those ≥65 years) were more likely to experience symptoms of regurgitation and cough than were younger patients. These symptoms do not respond as well to medical management as does the symptom of heartburn, so surgery is particularly appealing in this group. The authors assert that laparoscopic antireflux surgery is as safe in elderly patients as in the younger population, but is that correct? The outcomes reported in this article, including resolution of preoperative complaints, intraoperative complications, and postoperative complications of urinary retention, myocardial infarction, pneumonia, wound infection, and pleural effusion, were similar between age groups. Although the authors note that no patient in either group required admission to a skilled nursing facility after discharge, they do not specifically comment on cognitive function. We know that one quarter of patients 65 years or older experience delirium during hospitalization,2 and there is strong suspicion that this number underestimates the true rate.3 The long-term sequelae of postoperative delirium can be significant. If we extrapolate from the medical population, only one third of patients who experience delirium in the hospital will still live independently in the community 2 years later.4 Other studies have shown that the only predictor of postoperative cognitive dysfunction is age.5 As surgeons, we may be guilty of ascribing a little postoperative confusion to narcotics and preexisting mild dementia. If we do not look for it and define it as a postoperative complication, we may do our older patients a disservice. A higher degree of attention to postoperative mental changes and their long-term effects is needed before we can declare laparoscopic antireflux surgery to be as safe in elderly patients as in the younger population.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles