Primary and Redo Antireflux Surgery: Outcomes and Lessons Learned

Singhal, Saurabh; Kirkpatrick, Daniel R.; Masuda, Tomoyuki; Gerhardt, J.; Mittal, Sumeet K.

doi:10.1007/s11605-017-3480-4

Cited by 36 publications

(28 citation statements)

References 31 publications

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“…The reported success rate of subsequent revisions is lower than for the primary fundoplication, and continues to decrease with subsequent reoperations. 31, 36 The mortality rate for reoperation is approximately 1%, however complications of all types (perforation, postoperative leak, gastrotomy, vagal nerve injury and treatment failure) is significantly increased, particularly for multiple time redos. 37, 38 In a study of 940 patients undergoing primary or redo antireflux surgery fewer patients were satisfied with subsequent reinterventions at follow-up (Excellent satisfaction following: primary antireflux surgery 91%, first redo 76%, second redo 49%, and third redo 33%).…”

Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

“…Similarly, a higher proportion of patients were taking acid suppression at follow-up with subsequent reintervention (primary 24%, first redo 46%, second redo 67%, and third redo 78%). 36…”

Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

“…The most common reoperative intervention includes takedown of the previous fundoplication, redo fundoplication, and repair of a recurrent hiatal hernia if present. 36, 39, 40 Choice of reoperation will be helped by an assessment of peristaltic function and gastric emptying. If a shortened esophagus contributed to the primary failure, a redo fundoplication with Collis gastroplasty should be performed.…”

Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

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Complications of Antireflux Surgery

Yadlapati

Hungness

Pandolfino

2018

American Journal of Gastroenterology

101

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Antireflux surgery anatomically restores the antireflux barrier and is a therapeutic option for proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease or PPI intolerance. Laparoscopic fundoplication is the standard antireflux surgery, though its popularity has declined due to concerns regarding wrap durability and adverse events. As the esophagogastric junction is an anatomically complex and dynamic area subject to mechanical stress, wraps are susceptible to disruption, herniation or slippage. Additionally, recreating an antireflux barrier to balance bidirectional bolus flow is challenging, and wraps may be too tight or too loose. Given these complexities it is not surprising that post-fundoplication symptoms and complications are common. Perioperative mortality rates range from 0.1 to 0.2% and prolonged structural complications occur in up to 30% of cases. Upper gastrointestinal endoscopy with a comprehensive retroflexed examination of the fundoplication and barium esophagram are the primary tests to assess for structural complications. Management hinges on differentiating complications that can be managed with medical and lifestyle optimization versus those that require surgical revision. Reoperation is best reserved for severe structural abnormalities and troublesome symptoms despite medical and endoscopic therapy given its increased morbidity and mortality. Though further data are needed, magnetic sphincter augmentation may be a safer alternative to fundoplication.

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Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

“…Similarly, a higher proportion of patients were taking acid suppression at follow-up with subsequent reintervention (primary 24%, first redo 46%, second redo 67%, and third redo 78%). 36…”

Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

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Complications of Antireflux Surgery

Yadlapati

Hungness

Pandolfino

2018

American Journal of Gastroenterology

101

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“…В качестве показания к хирургическому лечению при аксиальных (I типа) хиатальных грыжах рассматривается неэффективность медикаментозной терапии гастроэзофагеального рефлюкса или развитие его осложнений (язв, стриктур, цилиндроклеточной метаплазии пищевода, бронхиальной астмы, хронического ларингита, рецидивирующего отита и др.) [1,11,[15][16][17].…”

unclassified

“…Анатомическими причинами рецидива хиатальных грыж после хирургического лечения считаются большие размеры пищеводного отверстия диафрагмы, механическая слабость мышечных ножек, вторичное или первичное укорочение пищевода. Физиологическими факторами, предрасполагающими к повторному смещению органов брюшной полости в средостение, являются дыхательные сокращения диафрагмы, в которых принимают участие все ее мышечные структуры, в том числе хиатальные ножки, а также перистальтические сокращения пищевода [1,2,4,6,11,[15][16][17].…”

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Causes of unsuccessful surgical treatment of hiatal hernia

et al. 2020

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Hiatal hernia is the most common type of visceral anatomy disorder, observed in people under 30 years of age in 10%, older than 50 years in 60%. Four types of hiatal hernias (IIV) are distinguished by the variant of the disturbances in the relationship between the esophagus, stomach, and diaphragm. Indications for surgical treatment of hiatal hernias are gastroesophageal reflux or anatomical disorders, which have a risk of developing life-threatening conditions (obstruction or necrosis of the stomach). An unresolved problem in this part of surgery is the high rate of disease recurrence, reaching 1015 4060%. The subjective reasons for the unsatisfactory results of surgical treatment of this pathology include technical errors in performing interventions (insufficient mobilization of the esophagus, stomach, legs of the diaphragm, incomplete excision of the hernial sac) and flaws in perioperative support (insufficient analgesia, vomiting, cough). The objective factors of the repeated displacement of the abdominal organs into the chest are the large size of the hiatal opening (more than 5 cm in maximum dimension), the insufficient mechanical strength of the legs of the diaphragm (hypotrophy, fibrosis) and the shortening of the esophagus (reduction of the abdominal part length less than 5 cm). Each of the noted factors plays a own role, together determining the success or failure of the surgical intervention. Understanding the basic principles and unresolved issues in this field of surgery is a prerequisite for its further development.

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