Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jul 1;274(1):78-85.
doi: 10.1097/SLA.0000000000004639.

Outcomes of Laparoscopic Redo Fundoplication in Patients With Failed Antireflux Surgery: A Systematic Review and Meta-analysis

Francisco Schlottmann  1 , Francisco Laxague  1 , Cristian A Angeramo  1 , Emmanuel E Sadava  1 , Fernando A M Herbella  2 , Marco G Patti  3
Affiliations
Meta-Analysis

Outcomes of Laparoscopic Redo Fundoplication in Patients With Failed Antireflux Surgery: A Systematic Review and Meta-analysis

Francisco Schlottmann et al. Ann Surg. .

Abstract

Objective: The aim of this meta-analysis was to summarize the current available evidence regarding the surgical outcomes of laparoscopic redo fundoplication (LRF).

Summary of background data: Although antireflux surgery is highly effective, a minority of patients will require a LRF due to recurrent symptoms, mechanical failure, or intolerable side-effects of the primary repair.

Methods: A systematic electronic search on LRF was conducted in the Medline database and Cochrane Central Register of Controlled Trials. Conversion and postoperative morbidity were used as primary endpoints to determine feasibility and safety. Symptom improvement, QoL improvement, and recurrence rates were used as secondary endpoints to assess efficacy. Heterogeneity across studies was tested with the Chi-square and the proportion of total variation attributable to heterogeneity was estimated by the inconsistency (I2) statistic. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) across all studies.

Results: A total of 30 studies and 2,095 LRF were included. The mean age at reoperation was 53.3 years. The weighted pooled proportion of conversion was 6.02% (95% CI, 4.16%-8.91%) and the meta-analytic prevalence of major morbidity was 4.98% (95% CI, 3.31%-6.95%). The mean follow-up period was 25 (6-58) months. The weighted pooled proportion of symptom and QoL improvement was 78.50% (95% CI, 74.71%-82.03%) and 80.65% (95% CI, 75.80%-85.08%), respectively. The meta-analytic prevalence estimate of recurrence across the studies was 10.71% (95% CI, 7.74%-14.10%).

Conclusions: LRF is a feasible and safe procedure that provides symptom relief and improved QoL to the vast majority of patients. Although heterogeneously assessed, recurrence rates seem to be low. LRF should be considered a valuable treatment modality for patients with failed antireflux surgery.

PubMed Disclaimer

Conflict of interest statement

Francisco Schlottmann, Francisco Laxague, Cristian A. Angeramo, Emmanuel E. Sadava, Fernando A.M. Herbella, and Marco G. Patti have no conflicts of interest, financial ties or funding/support to disclose.

References

    1. El-Serag HN, Sweet S, Winchester CC, et al. Update on the epidemiology of gastro-esophageal reflux disease: a systematic review. Gut 2014; 63:871–880.
    1. Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology 2002; 122:1500–1511.
    1. Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 2006; 101:2128–2138.
    1. Schlottmann F, Herbella FA, Allaix ME, et al. Surgical treatment of gastroesophageal reflux disease. World J Surg 2017; 41:1685–1690.
    1. Carlson MA, Frantzides CT. Complications and results of primarily minimally invasive antireflux procedures: a review of 10,735 reported cases. J Am Coll Surg 2001; 193:428–439.