Surgical experience in fifty-five consecutive reoperative fundoplications

Abstract

Laparoscopic antireflux surgery has dramatically changed the way heartburn and regurgitation have been managed over the last 10 years. The possibility of surgical correction with limited morbidity has resulted in a substantial increase in the number of fundoplications performed. Given that the rate of operative failure can be expected to be constant the need for surgical management of recurrent symptoms will become more prevalent. Between August 1996 and December 2001 55 patients presented with recurrent symptoms after a previous antireflux surgery. The presentation, management, and operative outcomes of patients undergoing reoperative fundoplication were studied. The 55 patients (25 male and 30 female) had a mean age of 47.1 years (range 22-69 years). Mean laparoscopic operative time was 234 minutes (range 180-330 minutes), and mean open time was 261 minutes (range 150-390 minutes). A laparoscopic repair was attempted in 45 patients and was completed without conversion in 37 (82.3%); seven of the eight patients requiring conversion had at least one prior open antireflux procedure. Average length of stay was 4.6 days (range one to 46 days); laparoscopic patients were in the hospital an average of 2 days (range one to 6 days). There were eight (12.7%) perioperative complications, no esophageal leaks, and no deaths. Average follow-up was 21.3 months (range 1-65 months). In patients who had a definitive antireflux procedure (53) 49 (92.5%) reported good to excellent outcomes; four had fair outcomes. All stated they were improved. Four patients reported occasional dysphagia, three reported intermittent nausea, five have infrequent to frequent chest pain, and four have diarrhea at least weekly. Despite being technically difficult reoperative fundoplication effectively alleviates dysphagia, regurgitation, and reflux symptoms in the majority of patients with low operative morbidity. The operation can be completed laparoscopically in most of those whose original operation was performed laparoscopically.