Original article
General thoracic
Failed Antireflux Surgery: Results After Reoperation

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.
https://doi.org/10.1016/j.athoracsur.2006.01.019Get rights and content

Background

Since laparoscopy has become a common surgical approach for antireflux surgery, little is known regarding reoperation for failed antireflux surgery.

Methods

Records of all patients who underwent reoperation without esophageal resection for symptoms of recurrent gastroesophageal reflux disease or hiatal hernia between July 1, 1995 and April 1, 2004 were reviewed. There were 126 patients. Two patients declined research participation. The remaining 124 patients (71 women and 53 men) formed the basis for this study. Median age was 53 years (range, 19 to 83 years). The initial operation was a laparoscopic antireflux procedure in 76 patients (61.3%) and an open repair in 48 (38.7%). A single previous operation had been done in 100 patients, two operations in 20, and three operations in 4. The median interval between the most recent reoperation and the previous operation was 28 months. All patients were symptomatic. The surgical approach was a thoracotomy in 83 patients, laparotomy in 36, laparoscopy in 4, and thoracoabdominal in 1. A Nissen fundoplication was performed in 86 patients (69.4%), Belsey fundoplication in 31(25.0%), and others in 7.

Results

There were no operative deaths. Complications occurred in 27 patients (21.7%). Median hospitalization was 6 days (range, 5 to 58 days). Follow-up ranged from 10 days to 10 years (median, 9.7 months). Improvement was observed in 114 patients (91.9%). Functional results were classified as excellent in 69 patients (55.6%), good in 19 (15.4%), fair in 26 (20.9%), and poor in 10 (8.1%). No single operative approach was functionally superior.

Conclusions

We conclude that reoperation for failed antireflux surgery is safe and effective. Results of reoperation were not affected by the type of reoperation or whether the previous approach was laparoscopic or open.

Section snippets

Material and Methods

All patients who underwent reoperation without esophageal resection for symptoms of recurrent gastroesophageal reflux disease or recurrent hiatal hernia at the Mayo Clinic in Rochester, Minnesota, between July 1, 1995 and April 1, 2004 were reviewed. There were 126 patients; however, 2 patients declined research participation and were excluded from further analysis. The medical records of the remaining 124 patients were analyzed for age, gender, symptoms, diagnostic evaluation, indications for

Results

Complications occurred in 27 patients (21.8%) (Table 1). There was no operative death. Median hospitalization was 6 days and ranged from 5 to 58 days. Follow-up ranged from 10 days to 10 years (median, 9.7 months). Overall, 114 patients (87.8%) were improved. Functional results were classified as excellent in 69 patients (55.7%), good in 19 (15.3%), fair in 26 (21.0%) and poor in 10 (8.0%) (Table 2). Six patients (3.2%) required another operation. Indications for further surgery were a

Comment

Laparoscopic fundoplication has become a well-established approach for gastroesophageal reflux disease [19]. As experience was gained, this procedure also expanded into repair of large paraesophageal hernias [20] and recurrent diaphragmatic hernias [21]. Today the failure after laparoscopic repair has become an increasingly common clinical condition [22, 23, 24] and in our experience the rate of failed antireflux surgery has more than doubled during the past decade (Table 3).

In 1995, Deschamps

References (27)

  • F.G. Pearson et al.

    Gastroplasty and fundoplication for complex reflux problems

    Ann Surg

    (1987)
  • J.R. Siewert et al.

    Reoperation following failed fundoplication

    World J Surg

    (1989)
  • D.B. Skinner

    Surgical management after failed antireflux operations

    World J Surg

    (1992)
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