Laparoscopic Redo Fundoplication Alone, Redo Nissen Fundoplication, or Toupet Fundoplication Combined With Roux-en-Y Distal Gastrectomy for Treatment of Failed Nissen Fundoplication

Abstract

BACKGROUND: Laparoscopic Nissen fundoplication fails to control the gastroesophageal reflux in almost 15% of patients, and most of them must be reoperated due to postoperative symptoms. Different surgical options have been suggested. AIMS: This study aimed to present the postoperative outcomes of patients submitted to three different procedures: redo laparoscopic Nissen fundoplication alone (Group A), redo laparoscopic Nissen fundoplication combined with distal gastrectomy (Group B), or conversion to laparoscopic Toupet combined with distal gastrectomy with Roux-en-Y gastrojejunostomy (Group C). METHODS: This is a prospective study involving 77 patients who were submitted initially to laparoscopic Nissen fundoplication and presented recurrence of gastroesophageal reflux after the operation. They were evaluated before and after the reoperation with clinical questionnaire and objective functional studies. After reestablishing the anatomy of the esophagogastric junction, a surgery was performed. None of the patients were lost during follow-up. RESULTS: Persistent symptoms were observed more frequently in Group A or B patients, including wrap stricture, intrathoracic wrap, or twisted fundoplication. In Group C, recurrent symptoms associated with this anatomic alteration were infrequently observed. Incompetent lower esophageal sphincter was confirmed in 57.7% of patients included in Group A, compared to 17.2% after Nissen and distal gastrectomy and 26% after Toupet procedure plus distal gastrectomy. In Group C, despite the high percentage of patients with incompetent lower esophageal sphincter, 8.7% had abnormal acid reflux after surgery. CONCLUSIONS: Nissen and Toupet procedures combined with Roux-en-Y distal gastrectomy are safe and effective for the management of failed Nissen fundoplication. However, Toupet technique is preferable for patients suffering from mainly dysphagia and pain.

Endoscopic Ablation Combined With Fundoplication Plus Acid Suppression-Duodenal Diversion Procedure for Long Segment Barrett´s Esophagus: Early and Long-Term Outcome

“…The role of surgery is to provide an absolute barrier to acid and bile contents. But, in patients with LSBE, fundoplication alone can fail to control acid and bile reflux 1 , 8 , 48 . Therefore, we must perform AS-DD to avoid both types of refluxes (acid and bile), to obtain optimal results in terms of eradication and no progression of histological alterations in the long term.…”

“…In recent decades, it is recognized as a good alternative, especially in obese patients, reporting IM regression in more than 90% and dysplasia regression in 60% of cases, without progression to dysplasia or adenocarcinoma. The proposed technique for eradicating IM with or without LGD could offer even greater success 8 , 12 , 15 , 38 . However, there is only one case previously reported 43 , and so, that is the reason this option requires validation with further studies.…”

Laparoscopic Antireflux Surgery: Are Old Questions Answered? Mesh Hernioplasty

“…The customary repair of hiatal hernia is composed of reduction of the stomach from the posterior mediastinum, excision of the hernia sac, and approximation of the hiatal crura around the esophagus, with or without a fundoplication 23 , 24 . Unfortunately, these hernias are prone to recurrence after repair 1 , 3 , 12 . Studies found that repair of recurrent hiatal hernia is becoming a more frequent indication for hiatal hernia surgery 3 , 24 , 25 .…”

“…Unfortunately, these hernias are prone to recurrence after repair 1 , 3 , 12 . Studies found that repair of recurrent hiatal hernia is becoming a more frequent indication for hiatal hernia surgery 3 , 24 , 25 .…”

A commentary on ‘Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernias with severe gastroesophageal reflux disease: a retrospective cohort study’

“…Esophageal hiatal hernia, most commonly type I sliding hiatal hernia (HH), is one of the leading causes of GERD 2 . Laparoscopic Nissen fundoplication (LNF) is currently recognized as the preferred surgery for the treatment of GERD 3 . Habeeb et al .…”