Background: Between 1993 and 1995, 315 anti-reflux procedures were undertaken on our service. A previous antireflux procedure had been performed in 31 patients referred (10%). Previous surgery was, in the main (go%), a Nissen fundoplication. Methods: Re-operative investigations in all patients were manometry, 24 h pH monitoring, oesophagoscopy and barium radiology. On this basis the causes of failure of the previous surgery were established as hiatal failure in 20 (65%), unrecognized oesophageal dysmotility in three ( 10%) and fundoplication failure (slipped and disrupted) in eight (25%). Contrary to standard recommendations for re-operation most re-operative surgery was performed transabdominally (94%). Complications occurred in 16%. Results: Review was undertaken at a mean of 21 months following surgery, and 91% of patients reported a good to excellent symptomatic outcome. Conclusions: Transabdominal re-operative anti-reflux surgery has an acceptable complication rate and a surprisingly good symptomatic outcome in the medium term.
Pancreatic pseudocyst is a common complication of acute or chronic pancreatitis, developing in up to 15% and 40% of these groups of patients. 1 Complications of pancreatic pseudocyst include infection, splenic vein thrombosis, rupture of pseudocyst, and massive hemorrhage into the pseudocyst. 2 Gastrointestinal (GI) bleeding is an uncommon but possible complication of pancreatic pseudocyst. This complication could occur after a fistula formation from the pseudocyst to the internal hollow organs. 3 Either upper or lower GI bleeding is possible according to the location of the fistula formation. [4][5][6] The gastric bleeding can be caused by the gastrocystic fistula formation and intracystic bleeding. Intracys-
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