Laparoscopic repair for failed antireflux procedures

Background. Minimally invasive procedures havebecome common, and more reoperations for failed antirefluxprocedures are performed laparoscopically. Wewanted to study the outcomes of laparoscopic reoperationsfor reflux.

Methods. Medical records of all patients who underwentreoperation without esophageal resection afterprevious antireflux procedures between January 2000 andOctober 2012 were reviewed.

Results. Seventy-five patients were included in thisreport: 56 (77%) women and 19 (23%) men. Median agewas 58 years. The previous operation was laparoscopicantireflux procedures in 65 (87%) patients. The medianinterval between the last antireflux procedure and laparoscopicreoperation was 42 months. The median bodymass index (BMI) was 28.7. All patients were symptomatic.Intraoperative findings included recurrent hiatalhernia in 47 (63%) patients, incompetent fundoplicationin 14 (19%) patients, tight fundoplication in 8 (11%) patients,and tight crura in 2 (3%) patients. LaparoscopicNissen fundoplication was performed in 57 (76%)patients, partial posterior fundoplication was performedin 12 (16%) patients, partial anterior fundoplication wasperformed in 3 (4%) patients, removal of crural stitcheswas performed in 2 patients, and a combination of partialposterior fundoplication and removal of crural sticheswas performed in 1 patient. Complications occurred in 13(15%) patients. Improvement in symptoms was observedin 70 (93%) patients in early postoperative follow-up andin 59 (78%) patients in long-term follow-up. Functionalresults were classified as excellent in 59 (78%) patients,good in 6 (7%) patients, fair in 7 (8%) patients, and poor in3 (4%) patients.

Conclusions. Laparoscopic reoperation for failed antirefluxoperations is a complex procedure, but it is safeand effective in selected patients. Reoperation after afailed antireflux repair results in excellent or good functionalstatus in a majority of patients, but these resultsmay deteriorate over time.