Secondary antireflux surgery

Abstract

Background & aim: With the introduction of laparoscopy, the number of antireflux surgeries (ARS), and consequently failed fundoplications, had increased. We report the mechanisms of fundoplication failure after ARS, and present our experience in surgical correction of failure.

Methods: Twenty nine patients who had failed fundoplication were reoperated. Pre- and postoperative evaluation of patients included symptom severity score, endoscopy, barium study, esophageal motility and pH metry.

Results: The initial procedures were Nissen in 16, Toupet in 10, and Nissen-Rossetti in 3 patients. The causes of failure were transdiaphragmatic migration of fundoplication (n=7), disrupted fundoplication (n=7), tight fundoplication (n=4), slipped fundoplication (n=3), paraesophageal herniation (n=3), tight crural repair (n=3), and migration with disruption (n=2). The secondary ARS performed were Nissen (n=16), Toupet (n=9), paraesophageal hernia repair with crural repair (n=2), widening of crural repair (n=1), and taking down fundoplication (n=1). Per- (n=4) and postoperative (n=5) complications were minor with no mortality. At Follow-up, symptoms were significantly improved.

Conclusion: Reoperations for failed ARS may be performed safely with excellent results. Proper patient selection and paying attention to some technical details at initial ARS could safe the patient another surgery.