Original articleGeneral thoracicFailed Antireflux Surgery: Results After Reoperation
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
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Laparoscopic Reoperative Antireflux Surgery Is More Cost-Effective than Open Approach
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2017, International Journal of SurgeryLaparoscopic reoperative antireflux surgery: A safe procedure with high patient satisfaction and low morbidity
2016, American Journal of SurgeryCitation Excerpt :There was a decrease in the use of PPI in the laparoscopic group: 21/25 (95%) vs. 12/25 (48%), p = 0.04. With an increasing number of laparoscopic antireflux surgeries, there is an increasing number of recurrent hiatal hernia cases referred to specialized centers for reoperative procedures.7,8 The reoperative antireflux procedure is complex and can be challenging as the result of technical difficulties, mostly caused by dense adhesions between the hernia sac, liver and mediastinal structures, and separation of the plane between the esophagus and the stomach to take down the prior fundoplication.
Laparoscopic repair for failed antireflux procedures
2014, Annals of Thoracic SurgeryCitation Excerpt :This reoperation rate is much higher than the recently reported rate of 3% to 6% [1] and reflects the tertiary nature of our practice. The key to a successful outcome includes both proper patient selection and careful operating technique [12]. An important factor a surgeon should consider in choosing the surgical approach is the likelihood that a safe and technically proper reconstruction of the antireflux mechanism can be performed [17].