Re‐operation for Failed Anti‐reflux Surgery

Abstract

Background: Between 1993 and 1995, 315 anti-reflux procedures were undertaken on our service. A previous antireflux procedure had been performed in 31 patients referred (10%). Previous surgery was, in the main (go%), a Nissen fundoplication. Methods: Re-operative investigations in all patients were manometry, 24 h pH monitoring, oesophagoscopy and barium radiology. On this basis the causes of failure of the previous surgery were established as hiatal failure in 20 (65%), unrecognized oesophageal dysmotility in three ( 10%) and fundoplication failure (slipped and disrupted) in eight (25%). Contrary to standard recommendations for re-operation most re-operative surgery was performed transabdominally (94%). Complications occurred in 16%. Results: Review was undertaken at a mean of 21 months following surgery, and 91% of patients reported a good to excellent symptomatic outcome. Conclusions: Transabdominal re-operative anti-reflux surgery has an acceptable complication rate and a surprisingly good symptomatic outcome in the medium term.

Surgical Reintervention After Failed Antireflux Surgery: A Systematic Review of the Literature

“…Data were obtained by questionnaires in 29 studies (36.7%),8,10,11,16–18,20,22–24,27,28,30,34–37,42,45,46,48,49,54,55,61,69,71,80,84 by interview in 21 (26.6%),13,25,31,38,41,47,52,53,57,60,62,65–68,73,74,78,82,83,85 and this was not reported in the remaining 29 studies (36.7%) 12,14,15,21,26,32,33,39,40,43,44,50,51,56,58,59,63,64,70,72,75–77,79,81,86–89. The mean success rate in studies only reporting on laparoscopic reoperations (17 studies)11–13,23–25,28,31,35,39,41,48,50,53,61,70,85 was 84.2 ± 2.5% and 84.6 ± 3.4% in studies in which all reoperations were performed by a conventional abdominal approach (ten studies) 10,22,33,44,58,…”

Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility

“…Most recent series of laparoscopic antireflux surgery reported a certain amount of adverse outcomes requiring subsequent surgical revision [12,37,[44][45][46]. The incidence varies with the length of postoperative follow-up and the criteria used for reporting.…”

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

“…31,33,40,[42][43][44][54][55][56][57][58][59][60] Many authors have recognized that recurrence of reflux may after occur laparoscopic surgery, but still have suggested the same route for its treatment. 36,45,51,[61][62][63] Watson et al, 45 Horgan et al, 62 and others 52 have presented their experience of reflux recurrence following repeat surgery for failed fundoplication by the laparoscopic approach and have concluded that the main cause pf failure is deficient fundoplication. It is possible to perform revisional surgery by the laparoscopic route, and good results can be obtained in spite of the technical difficulties that may be faced.…”