Strategies for surgical remediation of the multi-fundoplication failure patient

Antiporda, Michael; Jackson, Chloe; Smith, C. Daniel; Thomas, Mathew; Elli, Enrique F.; Bowers, Steven P.

doi:10.1007/s00464-018-6429-0

Cited by 18 publications

(6 citation statements)

References 19 publications

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Section: Reconstructive Optionsmentioning

confidence: 99%

“…17 Most authors endorse the feasibility of an initial laparoscopic approach regardless of previous laparotomy status, with conversion to open or exposure through a thoracotomy as needed, and based on surgeon's experience. 18,20 Roux-en-Y gastrojejunostomy (RNYGJ) has become one of the most commonly performed procedures in the United States, and increasingly utilized in failed fundoplication as an effective alternative option. 24 Candidates for RNY reconstruction are described with more risk factors for poor reflux control and hernia recurrence compared to patients undergoing redo-fundoplication, Table 2.…”

Section: Roux-en-y Reconstructionmentioning

confidence: 99%

“…10 Other indications have been extracted from contemporary studies addressing resectional surgery in failed ARS and are listed in Table 1. 10,[16][17][18][19][20] These indications underscore the need for a complete perioperative workup in order to select the appropriate surgical procedure.…”

Section: Indications For Esophago-gastric Junction Resectionmentioning

confidence: 99%

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Indications and Options for Esophago-Gastric Junction Resection and Reconstruction in Failed Anti-Reflux Surgery

Wisniowski

Lipham

2023

Foregut: The Journal of the American Foregut Society

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Revisional anti-reflux surgery is complex. The most common revisional procedure following anti-reflux surgery is redo-fundoplication; however, there is a rate of diminishing return for each subsequent redo-fundoplication. In addition, postoperative complications involving the gastroesophageal junction or intraoperative complications may require resection of the gastroesophageal junction and reconstruction. There is limited data evaluating the options for patients undergoing resectional surgery following ARS, but this paper will review the current literature and provide an overview on the indications and reconstructive options following gastro-esophageal junction resection.

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Section: Reconstructive Optionsmentioning

confidence: 99%

Section: Roux-en-y Reconstructionmentioning

confidence: 99%

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Indications and Options for Esophago-Gastric Junction Resection and Reconstruction in Failed Anti-Reflux Surgery

Wisniowski

Lipham

2023

Foregut: The Journal of the American Foregut Society

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“…FO failure in previous studies has been defined as a need for a revisional antireflux operation, patient dissatisfaction with the outcome, or the presence of at least 1 severe symptom post-surgery [ 5 ]. Failure rates are quite variable in the literature, ranging between 2% and 50% at 5-year follow up [ 1 , 6 ]. Others have noted a need for antisecretory medications in 50% of patients up to 10 years post-operation [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Association of preoperative workup and comorbidities with risk of gastroesophageal surgery failure

Ventura

2024

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Background While surgical failure rates for fundoplication and hiatal hernia repair are low, there has been no clear evaluation of the preoperative risk factors associated with surgical failure. This study aimed to identify risk factors predisposing patients to surgical failure. Methods Patients who underwent antireflux surgery during a 3-year period were evaluated for evidence of surgical complications and placed accordingly into the failure or control group. Demographic data, comorbidities, clinical presentation, preoperative evaluation, and surgical data were collected and compared between the groups. Results In total, 86 patients with failure and 42 controls were identified among our cohort. No significant differences were found between groups based on sex (P=0.640). However, patients with failure were younger than controls (57.0 vs. 64.7 years, P=0.0001). Body mass index, tobacco use and alcohol use did not differ significantly between the groups (P=0.189, P=0.0999, P=0.060). Notably, psychiatric illness was more common in the failure group (P=0.0086). Neither hypertension (P=0.134) nor diabetes (P=0.335) had significant differences between groups. For procedures, no significant differences were found for the frequencies of preoperative imaging (P=0.395) or manometry (P=0.374), but pH/BRAVO studies (P=0.0193) and endoscopy (P<0.001) were both performed more frequently in the failure group. Conclusions Patients with psychiatric comorbidities are at higher risk of surgical failure. Alcohol use trended toward significance, which warrants further investigation. We also noted an increase in rates of preoperative pH and endoscopy studies, contrary to the prior literature; this is likely due to more complex cases requiring additional workup.

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“…[3][4][5][6] While durable symptom control is achieved in most patients, approximately 3% to 10% of primary fundoplication patients require a reoperation for recurrence. [7][8][9] Given known significant intraoperative complication and postoperative morbidity of reoperative antireflux surgery, prudent decision-making and discerning diagnostics become imperative before embarking on revisional surgery, especially given similarities between symptoms of recurrent GERD and myriad of other foregut symptoms versus expectant postoperative course. 10 Most antireflux fundoplication procedures are completed using a laparoscopic approach, including the total or Nissen fundoplication and the partial anterior or posterior fundoplication.…”

Section: Introductionmentioning

confidence: 99%

Surgical Perspective on Evaluation and Management of Recurrent Reflux After Primary Antireflux Surgery

Shin

Kroh

2023

Foregut: The Journal of the American Foregut Society

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While fundoplication as a treatment for gastroesophageal reflux disease (GERD) has been largely successful, the rise in reflux cases refractory to initial surgery presents a unique challenge in the search for more durable symptom relief. In addition to principles pertaining to medical management and reoperation, this article discusses several nuances to consider in the careful evaluation of recalcitrant GERD post-fundoplication to optimize long-term success after revisional antireflux surgery from a surgical perspective.

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Strategies for surgical remediation of the multi-fundoplication failure patient

Cited by 18 publications

References 19 publications

Indications and Options for Esophago-Gastric Junction Resection and Reconstruction in Failed Anti-Reflux Surgery

Indications and Options for Esophago-Gastric Junction Resection and Reconstruction in Failed Anti-Reflux Surgery

Association of preoperative workup and comorbidities with risk of gastroesophageal surgery failure

Surgical Perspective on Evaluation and Management of Recurrent Reflux After Primary Antireflux Surgery

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