Outcome of laparoscopic redo fundoplication

Abstract

Background: To date, there has been no objective evidence for the effectiveness of laparoscopic redo fundoplication. We therefore reviewed our experience and based our analysis on a number of objective parameters.

Methods: We prospectively followed 28 consecutive patients (five men and 23 women; mean age, 48.64 +/- 2.57 years) who required redo fundoplication. These patients were part of a series of laparoscopic Nissen fundoplications done between 1992 and 2001. The indications were recurrent symptoms of gastroesophageal reflux disease (GERD) (21 patients), acute herniation of the wrap (three patients), and chronic paraesophageal hernia (four patients). A diagnosis of recurrent GERD was based on endoscopy, 24-h pH study, manometry, and symptom score evaluation. A diagnosis of paraesophageal and acute herniation was based on contrast swallow studies and/or gastroscopy.

Results: Twenty-six redo fundoplications were completed laparoscopically; two were converted to open. The mean operative time was 55.43 +/- 3.81 min. There were no intraoperative complications. The mean hospital stay was 3.0 +/- 0.35 days. Postoperative complications included postoperative pneumonia in one patient. Two patients from the laparoscopic group required a third operation-one for acute herniation of the redo wrap, which was fixed laparoscopically, and the other for acute recurrent paraesophageal hernia, which was fixed via an open transthoracic approach. The mean follow-up after revision is 25.14 +/- 3.48 months, with a significant decrease in acid reflux from 5.01% +/- 0.99 to 0.48% +/- 0.23 ( p < 0.0001), a significant decrease in symptom score from 28.96 +/- 2.93 to 10.75 +/- 2.61 ( p < 0.0001), and a small but significant increase in lower esophageal sphincter (LES) pressure from 13.71 +/- 1.79 to 16.69 +/- 1.50 ( p = 0.04).

Conclusions: Laparoscopic redo fundoplication is technically feasible and clinically effective over a 2-year objective follow-up. Conversion and complication rates are low.