Failed fundoplications

Hatch, Kathryn F.; Daily, Michael F.; Christensen, Brent J.; Glasgow, Robert E.

doi:10.1016/j.amjsurg.2004.08.062

Cited by 61 publications

(45 citation statements)

References 20 publications

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“…5,[16][17][18][19][20][21][22]26,27,30,31,[45][46][47][48][49] The aggregate of published evidence suggests that revision laparoscopic fundoplication and hiatal herniorraphy is effective, but technically challenging; thus, these revisional procedures should probably be performed in specialty centers. More important, however, are lessons learned in minimizing failure after primary operation.…”

Section: Resultsmentioning

confidence: 99%

“…5,[16][17][18][19][20][21][22][23] Others have noted issues with the hiatal disruption during laparoscopic revision fundoplication. 8,16,18,19,22,[24][25][26][27][28][29][30][31][32][33][34] Herniation of the wrap, whether due to short esophagus or inadequate repair of the hiatus, is a primary mechanism of failure after minimally invasive fundoplication. We feel that this is almost always secondary to an inadequate repair of the esophageal hiatus or insufficient esophageal mobilization, as opposed to a shortened esophagus.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Frantzides

Madan

Carlson

et al. 2009

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Objective: The aim of this study was to evaluate the mechanisms of failure after laparoscopic fundoplication and the results of revision laparoscopic fundoplication. Background: Laparoscopic Nissen fundoplication has become the most commonly performed antireflux procedure for the treatment of gastroesophageal reflux disease, with success rates from 90 to 95%. Persistent or new symptoms often warrant endoscopic and radiographic studies to find the cause of surgical failure. In experienced hands, reoperative antireflux surgery can be done laparoscopically. We performed a retrospective analysis of all laparoscopic revision of failed fundoplications done by the principle author and the respective fellow within the laparoscopic fellowship from 1992 to 2006. Methods: A review was performed on patients who underwent laparoscopic revision of a failed primary laparoscopic fundoplication. Results: Laparoscopic revision of failed fundoplication was performed on 68 patients between 1992 and 2006. The success rate of the laparoscopic redo Nissen fundoplication was 86%. Symptoms prior to the revision procedure included heartburn (69%), dysphagia (8.8%), or both (11.7%). Preoperative evaluation revealed esophagitis in 41%, hiatal hernia with esophagitis in 36%, hiatal hernia without esophagitis in 7.3%, stenosis in 11.74%, and dysmotility in 2.4%. The main laparoscopic revisions included fundoplication alone (41%) or fundoplication with hiatal hernia repair (50%). Four gastric perforations occurred; these were repaired primarily without further incident. An open conversion was performed in 1 patient. Length of stay was 2.5 Ϯ 1.0 days. Mean follow-up was 22 months (range, 6-42), during which failure of the redo procedure was noted in 9 patients (13.23%). Conclusion: Laparoscopic redo antireflux surgery, performed in a laparoscopic fellowship program, produces excellent results that approach the success rates of primary operations. 135

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Frantzides

Madan

Carlson

et al. 2009

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…In all reoperated patients after Rossetti LTF there were twisted valves involving the gastric body (not just the fundus, as recommended), with obvious structural abnormality. This corresponds to a type III alteration, as described by Horgan (16) in which the most common manifestation is dysphagia (15,16) . Thus, a new total fundoplication involving the anterior and posterior gastric walls, adequately positioned, and was used by us for treating dysphagia in two cases.…”

Section: Resultsmentioning

confidence: 84%

DYSPHAGIA AFTER LAPAROSCOPIC TOTAL FUNDOPLICATION: anterior or posterior gastric wall fundoplication?

Bonadiman

Teixeira

Goldenberg

et al. 2014

Arq. Gastroenterol.

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-Context -The occurrence of severe dysphagia after laparoscopic total fundoplication is currently an important factor associated with loss of quality of life in patients undergoing this modality of treatment for gastroesophageal reflux disease. Objective -Compare the incidence and evaluate the causes of severe postoperative dysphagia in patients undergoing laparoscopic total fundoplication (LTF) without short gastric vessels division, using the anterior gastric wall (Rossetti LTF) or anterior and posterior gastric walls (Nissen LTF). Methods -Analysis of the data of 289 patients submitted to LTF without short gastric vessels division from January 2004 to January 2012, with a minimum follow-up of 6 months. Patients were divided in Group 1 (Rossetti LTF -n = 160) and Group 2 (Nissen LTF -n = 129). Results -The overall incidence of severe postoperative dysphagia was 3.11% (4.37% in group 1 and 1.55% in group 2; P = 0.169). The need for surgical treatment of dysphagia was 2.5% in group 1 and 0.78% in group 2 (P = 0.264). Distortions of the fundoplication were identified as possible causes of the dysphagia in all patients taken to redo fundoplication after Rossetti LTF. No wrap distortion was seen in redo fundoplication after Nissen LTF. Conclusion -The overall incidence of severe postoperative dysphagia did not differ on the reported techniques. Only Rossetti LTF was associated with structural distortion of the fundoplication that could justify the dysphagia.

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“…After laparoscopic fundoplication, anatomic alterations of the EGJ are observed in 2% in non-Barrett's esophagus patients versus 16% in patients with Barrett's esophagus. [19][20][21][22][23][24][25][26][27][28] Martínez de Haro et al, 29 in 51 patients with reflux esophagitis followed for more than 6 years, obtained good results in 89% of patients, but endoscopic recurrence was higher (14%) and pathologic acid reflux confirmed by 24-hour pH monitoring was 20% after surgery. In Barrett's esophagus patients, the results are even worse.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20][21][22] However, there are several citations in the literature reporting failure rates of laparoscopic fundoplication from 2% to 17%. [22][23][24][25][26][27][28] These lower published rates probably reflect shorter follow-up rather than an intrinsically better operation. Besides, the majority of these reports do not include objective evaluation of the success or failure of antireflux surgery, such as endoscopic appearance, manometric measurements, or 24-hour pH studies.…”

Section: Discussionmentioning

confidence: 99%

Radiologic and Endoscopic Characteristics of Laparoscopic Antireflux Wrap: Correlation With Outcome

Braghetto

Korn

Csendes

et al. 2012

International Surgery

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After antireflux surgery for gastroesophageal reflux disease, 10% to 15% of patients may have unsuccessful results as a result of abnormal restoration of the esophagogastric junction. The purpose of this study was to evaluate the postoperative endoscopic and radiologic characteristics of the antireflux barrier and their correlation with the postoperative results. After surgery, endoscopic and radiologic features of the antireflux wrap were evaluated in 120 consecutive patients. Jobe's classification of the postoperative valve was used for the definition of a ''normal'' or ''defective'' wrap. Patients were evaluated 3 to 5 years later in order to determine the clinical and objective failed fundoplication. A ''normal'' antireflux wrap was associated with successful results in 81.7% of the patients. On the contrary, defective radiologic or endoscopic antireflux wrap was observed in 19% of cases. Among these patients, hypotensive lower esophageal sphincter was observed in 50% to 65% of patients, abnormal 24-hour pH monitoring in 91%, and recurrent postoperative erosive esophagitis in 50% of patients, respectively (P , 0.001). ''Defective'' antireflux fundoplication is associated with recurrent reflux symptoms, presence of endoscopic esophagitis, hypotensive lower esophageal sphincter, and abnormal acid reflux.Key words: Antireflux surgery -Postoperative failures -Defective fundoplication P atients with gastroesophageal reflux disease (GERD) have anatomic defects of the esophagogastric junction (EGJ) as dilatation of the cardia and/or presence of hiatal hernia. [1][2][3][4] These defects have been associated with incompetence of the lower esophageal sphincter (LES) and pathologic acid reflux. The aim of antireflux surgery is to create an antireflux barrier by increasing the competence of the LES and to avoid this abnormal acid reflux. However, failure of antireflux surgery has been reported in several publications and pathologic acid reflux test can be observed in 5% to 15% of GERD patients. 5,6 Zaninotto et al 6 reported 13.2% of reflux recurrence in patients with GERD (6.2% in patients with grade 0 to I esophagitis and 7% in patients with grade-II esophagitis, respectively). Presence of abnormal acid reflux has been reported after Nissen fundoplication as well as after Toupet or cardial calibration in a very similar percentage of cases. 7-9The restoration of the cardial anatomic integrity is followed by a successful outcome after surgery. On the contrary, some authors have published endoscopic or radiologic failures after fundoplication, with defective antireflux wrap associated with a high rate of symptomatic and objective reflux recurrence reaching up to 25% of cases. 2,10The purpose of this prospective study was to correlate the presence of postoperative radiologic and endoscopic defects of the new antireflux barrier after surgery and its association with persistence of symptoms, endoscopic esophagitis, hypotensive LES, and abnormal 24-hour pH monitoring. Patients and Methods Patients studiedIn this prospective ...

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Failed fundoplications

Abstract: Laparoscopic revisional antireflux surgery is effective treatment for patients with failed primary fundoplications. Successful revisional surgery depends on identification and correction of the reason for primary fundoplication failure.

Cited by 61 publications

References 20 publications

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

DYSPHAGIA AFTER LAPAROSCOPIC TOTAL FUNDOPLICATION: anterior or posterior gastric wall fundoplication?

Radiologic and Endoscopic Characteristics of Laparoscopic Antireflux Wrap: Correlation With Outcome

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