دورية أكاديمية
أعرض في EDS

Safety and efficacy of robotic anti-reflux surgery in geriatric patients: a comparative analysis.

التفاصيل البيبلوغرافية
العنوان: Safety and efficacy of robotic anti-reflux surgery in geriatric patients: a comparative analysis.
المؤلفون: Marshall TE; 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. Tem9029@nyp.org., Alqamish M; 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., Salehi N; 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., Al Asadi H; 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., Lee-Saxton YJ; 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., Tumati A; 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., Greenspun B; 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., Finnerty BM; 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., Fahey TJ 3rd; 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., Zarnegar R; 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.
المصدر: Surgical endoscopy [Surg Endosc] 2024 Sep; Vol. 38 (9), pp. 5285-5291. Date of Electronic Publication: 2024 Jul 15.
نوع المنشور: Journal Article; Comparative Study
اللغة: English
بيانات الدورية: Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE
أسماء مطبوعة: Publication: 1992- : New York : Springer
Original Publication: [Berlin] : Springer International, c1987-
مواضيع طبية MeSH: Robotic Surgical Procedures*/methods , Robotic Surgical Procedures*/adverse effects , Gastroesophageal Reflux*/surgery , Postoperative Complications*/epidemiology , Postoperative Complications*/etiology, Humans ; Aged ; Female ; Male ; Treatment Outcome ; Retrospective Studies ; Aged, 80 and over ; Fundoplication/methods ; Fundoplication/adverse effects ; Length of Stay/statistics & numerical data ; Quality of Life ; Patient Readmission/statistics & numerical data ; Reoperation/statistics & numerical data
مستخلص: Introduction: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
References: Becher A, Dent J (2011) Systematic review: ageing and gastro-oesophageal reflux disease symptoms, oesophageal function and reflux oesophagitis. Aliment Pharmacol Ther 33(4):442–454. https://doi.org/10.1111/j.1365-2036.2010.04542.x. (PMID: 10.1111/j.1365-2036.2010.04542.x21138458)
Addo A, Sanford Z, Broda A, Zahiri HR, Park A (2021) Age-related outcomes in laparoscopic hiatal hernia repair: is there a “too old” for antireflux surgery? Surg Endosc 35(1):429–436. https://doi.org/10.1007/s00464-020-07489-5. (PMID: 10.1007/s00464-020-07489-532170562)
Pizza F, Rossetti G, Limongelli P et al (2007) Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease. World J Gastroenterol 13(5):740–747. https://doi.org/10.3748/wjg.v13.i5.740. (PMID: 10.3748/wjg.v13.i5.740172781974066007)
Fei L, Rossetti G, Moccia F et al (2013) Is the advanced age a contraindication to GERD laparoscopic surgery? Results of a long term follow-up. BMC Surg 13(2):S13. https://doi.org/10.1186/1471-2482-13-S2-S13. (PMID: 10.1186/1471-2482-13-S2-S13242676133851262)
Cowgill SM, Arnaoutakis D, Villadolid D et al (2006) Results after laparoscopic fundoplication: does age matter? Am Surg 72(9):778–784. https://doi.org/10.1177/000313480607200904. (PMID: 10.1177/00031348060720090416986386)
Levinson W (2002) Scientific review and clinical applications. JAMA 287(3):379. https://doi.org/10.1001/jama.287.3.379. (PMID: 10.1001/jama.287.3.379)
Watt J, Tricco AC, Talbot-Hamon C et al (2018) Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis. BMC Med 16(1):2. https://doi.org/10.1186/s12916-017-0986-2. (PMID: 10.1186/s12916-017-0986-2293255675765656)
Aprea G, Ferronetti A, Canfora A et al (2012) GERD in elderly patients: surgical treatment with Nissen-Rossetti laparoscopic technique, outcome. BMC Surg 12(1):S4. https://doi.org/10.1186/1471-2482-12-S1-S4. (PMID: 10.1186/1471-2482-12-S1-S4231737513499210)
Tolone S, Docimo G, Del Genio G et al (2013) Long term quality of life after laparoscopic antireflux surgery for the elderly. BMC Surg 13(2):S10. https://doi.org/10.1186/1471-2482-13-S2-S10. (PMID: 10.1186/1471-2482-13-S2-S10242674463851040)
Liu L, Lewis N, Mhaskar R, Sujka J, DuCoin C (2023) Robotic-assisted foregut surgery is associated with lower rates of complication and shorter post-operative length of stay. Surg Endosc 37(4):2800–2805. https://doi.org/10.1007/s00464-022-09814-6. (PMID: 10.1007/s00464-022-09814-636477641)
Napolitano MA, Zebley JA, Wagner K et al (2022) Robotic foregut surgery in the veterans health administration: increasing prevalence, decreasing operative time, and improving outcomes. J Am Coll Surg 235(2):149. https://doi.org/10.1097/XCS.0000000000000218. (PMID: 10.1097/XCS.000000000000021835839388)
John AD, Sieber FE (2004) Age associated issues: geriatrics. Anesthesiol Clin N Am 22(1):45–58. https://doi.org/10.1016/S0889-8537(03)00119-6. (PMID: 10.1016/S0889-8537(03)00119-6)
Bazaz R, Lee MJ, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine 27(22):2453–2458. https://doi.org/10.1097/00007632-200211150-00007. (PMID: 10.1097/00007632-200211150-0000712435974)
Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20(2):130–134. https://doi.org/10.1111/j.1442-2050.2007.00658.x. (PMID: 10.1111/j.1442-2050.2007.00658.x17439596)
Gu D, Andreev K, Dupre ME (2021) Major trends in population growth around the world. China CDC Wkly 3(28):604–613. https://doi.org/10.46234/ccdcw2021.160. (PMID: 10.46234/ccdcw2021.160345949468393076)
Horvath KD, Swanstrom LL, Jobe BA (2000) The short esophagus: pathophysiology, incidence, presentation, and treatment in the era of laparoscopic antireflux surgery. Ann Surg 232(5):630–640. (PMID: 10.1097/00000658-200011000-00003110661331421216)
O’Rourke RW (2003) Extended transmediastinal dissection: an alternative to gastroplasty for short esophagus. Arch Surg 138(7):735. https://doi.org/10.1001/archsurg.138.7.735. (PMID: 10.1001/archsurg.138.7.73512860754)
Awshah S, Mhaskar R, Diab ARF et al (2024) Robotics vs laparoscopy in foregut surgery: systematic review and meta-analysis analyzing hiatal hernia repair and Heller myotomy. J Am Coll Surg. https://doi.org/10.1097/XCS.0000000000001074. (PMID: 10.1097/XCS.000000000000107438497555)
فهرسة مساهمة: Keywords: Anti-reflux surgery; GERD; Gastroesophageal reflux disease; Geriatric surgery; Robotic outcomes
تواريخ الأحداث: Date Created: 20240715 Date Completed: 20240829 Latest Revision: 20240829
رمز التحديث: 20240830
DOI: 10.1007/s00464-024-11037-w
PMID: 39009731
قاعدة البيانات: MEDLINE
الوصف
تدمد:1432-2218
DOI:10.1007/s00464-024-11037-w