Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Abstract

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

Reoperative laparoscopic paraesophageal herniorrhaphy can produce excellent outcomes

“…These results are consistent with prior studies, which demonstrated postoperative resolution or improvement of typical symptoms [8,15,[18][19][20]. Study results showed excellent symptom resolution following both primary and reoperative paraesophageal herniorrhaphy, as evidenced by significant reductions in all composite and individual esophageal and extraesophageal symptom scores in the follow-up period when compared with preoperative scores.…”

“…Several studies have examined symptom resolution with reoperative paraesophageal herniorrhaphy [1,11,12,14,15,17], but a comprehensive evaluation of symptoms in both primary and reoperative paraesophageal herniorrhaphy has not been performed. This study was a retrospective analysis of symptom resolution following reoperative paraesophageal herniorrhaphy and examined the clinical benefit and efficacy of reoperative paraesophageal herniorrhaphy.…”

“…Laparoscopic paraesophageal herniorrhaphy has been shown to produce complete or partial resolution of esophageal symptoms such as heartburn, regurgitation, and dysphagia and extraesophageal symptoms such as hoarseness, chronic cough, and laryngitis [2,14]. Many prior studies have evaluated resolution of specific symptoms such as heartburn and dysphagia following reoperative paraesophageal herniorrhaphy [11,12,14,15]. However, a comprehensive analysis of symptom resolution following reoperative paraesophageal herniorrhaphy has not been performed.…”

A comprehensive review of laparoscopic redo fundoplication

“…The application of the inclusion and exclusion criteria using information available in the published abstracts left 35 articles for a full review. From this pool, the final 17 articles were selected [9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. An additional review of the references in these final 17 articles yielded no additional publications for inclusion in the analysis.…”

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

“…Well-positioned valves, without evidences of structural defects, can be adequately treated with endoscopic dilation as a first choice; nonetheless, patients with twisted, migrated or anatomically disrupted fundoplications rarely respond satisfactorily to endoscopic treatment and should be taken to early surgical correction (5) . It is worth noting that although some studies have reported satisfactory results after revisional laparoscopic fundoplication (11,25) redo fundoplications usually have worse results than primary surgery (12,23) . For the Nissen LTF, we realize an extensive mobilization of the gastric fundus, with opening and dissection of the The ANOVA and the Equality of Two Proportions Tests were used for statistical analysis of quantitative and qualitative data, respectively.…”