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

Abstract

BackgroundOutcome and morbidity of redo antireflux surgery are suggested to be less satisfactory than those of primary surgery. Studies reporting on redo surgery, however, are usually much smaller than those of primary surgery. The aim of this study was to summarize the currently available literature on redo antireflux surgery.Material and MethodsA structured literature search was performed in the electronic databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials.ResultsA total of 81 studies met the inclusion criteria. The study design was prospective in 29, retrospective in 15, and not reported in 37 studies. In these studies, 4,584 reoperations in 4,509 patients are reported. Recurrent reflux and dysphagia were the most frequent indications; intraoperative complications occurred in 21.4% and postoperative complications in 15.6%, with an overall mortality rate of 0.9%. The conversion rate in laparoscopic surgery was 8.7%. Mean(±SEM) duration of surgery was 177.4 ± 10.3 min and mean hospital stay was 5.5 ± 0.5 days. Symptomatic outcome was successful in 81.1% and was equal in the laparoscopic and conventional approach. Objective outcome was obtained in 24 studies (29.6%) and success was reported in 78.3%, with a slightly higher success rate in case of laparoscopy than with open surgery (85.8% vs. 78.0%).ConclusionThis systematic review on redo antireflux surgery has confirmed that morbidity and mortality after redo surgery is higher than after primary surgery and symptomatic and objective outcome are less satisfactory. Data on objective results were scarce and consistency with regard to reporting outcome is necessary.

Pressure of the lower esophageal sphincter as a prognostic test result of antireflux surgery

“…Рецидив симптомов рефлюкса или появление стойкой дисфагии в по-слеоперационном периоде являются признаками неудачной фундопликации [12].…”

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

“…Severe and persistent postoperative dysphagia after LTF is the main cause of reoperations in GERD´s surgical treatment, posing a major concern for the enthusiasts of this type of treatment (2,12,17) The proper investigation of this complication is mandatory for the adequate selection of the treatment. 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) .…”

“…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.…”

Before and after Esophageal Surgery: Which Information Is Needed from the Functional Laboratory

“…Revisional surgery following laparoscopic fundoplication becomes necessary due to recurrent reflux in most of the patients (42%), dysphagia (17%) (tight wrap or scarring of the wrap), the combination of both (4%), anatomical abnormalities (2.5%), and gas bloat syndrome (0.7%) as the result of an underlying combined denervation of the vagal nerve with delayed gastric empty- ing (functional pyloric obstruction) and abnormal aerophagia [10]. According to Hatch et al [11], there are three types of wrap dysfunctions/dislocations, all necessitating redo ARS.…”