Laparoscopic reoperation following failed antireflux surgery

Watson, David I.; Jamieson, G. G.; Game, Philip A.; Williams, Randolph S.; Devitt, Peter G.

doi:10.1046/j.1365-2168.1999.00976.x

Cited by 82 publications

(58 citation statements)

References 12 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%

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%

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Frantzides

Madan

Carlson

et al. 2009

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…This may also explain the higher failure rates and increased postoperative dysphagia reported by some authors. 8 Decades of experience with open fundoplications have established certain principles and surgical techniques as essential for successful surgical outcomes. These concepts include thorough preoperative testing, routine division of the short gastric vessels, crural closure, and repairs performed without tension around a 2.5-to 3-cm length of intraabdominal esophagus.…”

Section: Discussionmentioning

confidence: 99%

The Short Esophagus: Pathophysiology, Incidence, Presentation, and Treatment in the Era of Laparoscopic Antireflux Surgery

Horvath¹,

Swanström²,

Jobe³

2000

Annals of Surgery

175

127

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“…36 The majority of authors agree that the main reasons for failures are technical errors in the performance of surgery such as asymmetric wrap, early disruption, wrap migration, and slipped fundoplication producing abnormal deformities, clearly demonstrated by radiologic and endoscopic assessment. [37][38][39][40][41][42] The recurrence rate of erosive esophagitis resulting from failure of antireflux operation ranges from 3% to 16%, most of them caused by a misperformed surgical procedure with a high proportion of positive acid reflux tests after the operation. 23 Mickevicius et al 43 suggests that a wrap length is important in fundoplication in order to avoid postsurgical failures.…”

Section: Discussionmentioning

confidence: 99%

“…[37][38][39][40][41][42] The recurrence rate of erosive esophagitis resulting from failure of antireflux operation ranges from 3% to 16%, most of them caused by a misperformed surgical procedure with a high proportion of positive acid reflux tests after the operation.…”

mentioning

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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Laparoscopic reoperation following failed antireflux surgery

Abstract: Laparoscopic reoperative antireflux surgery is feasible. Reoperation is likely to be more difficult following failure of an open procedure than a laparoscopic one.

Cited by 82 publications

References 12 publications

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

The Short Esophagus: Pathophysiology, Incidence, Presentation, and Treatment in the Era of Laparoscopic Antireflux Surgery

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

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