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Comparative Study
. 2025 Apr;169(4):1155-1161.
doi: 10.1016/j.jtcvs.2024.09.015. Epub 2024 Sep 16.

Laparoscopic revisional antireflux and hiatal hernia surgery results in a higher rate of complications and severity at 90 days than primary surgery

Ricardo Fraticelli Rosado  1 , Megan L Ivy  1 , Alexander S Farivar  1 , Candice L Wilshire  1 , Adam J Bograd  1 , Peter T White  1 , Brian E Louie  2
Affiliations
Comparative Study

Laparoscopic revisional antireflux and hiatal hernia surgery results in a higher rate of complications and severity at 90 days than primary surgery

Ricardo Fraticelli Rosado et al. J Thorac Cardiovasc Surg. 2025 Apr.

Abstract

Objective: Data on graded complications and their frequency after laparoscopic revisional antireflux and hiatal hernia surgery compared with primary surgery are lacking. We describe 30- and 90-day morbidity using the Clavien-Dindo classification.

Methods: A total of 298 patients underwent revision surgery between 2003 and 2020 and were propensity matched to primary surgeries (1:2 ratio) based on age, sex, body mass index, American Society of Anesthesiology classification, Los Angeles grade esophagitis, presence of Barrett's, and indication for surgery. Complications were graded using the Clavien-Dindo classification, with the highest grade of complication reported per patient.

Results: After matching, both groups had a majority of female patients, with a median age of 60 years and a median body mass index of 29.5 kg/m2. Most were healthy, with nonerosive esophagitis and modest levels of Barrett's esophagus. A laparoscopic Nissen fundoplication was most common; however, a partial fundoplication was more common in revisions. Mesh, relaxing incisions, and Collis were more common in revisional surgery. At 30 days, total complications were similar (23.5% [70/298] vs 20.6% [123/596], P = .373) with 1 death in each group. Minor complications (less than Clavien-Dindo 3A) were comparable. Patients undergoing revisional surgery experienced Clavien-Dindo 3B complications (4.7% [14] vs 0.8% [5], P > .001) more frequently, with esophageal obstruction requiring revision and esophageal/gastric leak being most common. Grade Clavien-Dindo 4 A/B complications were comparable in both groups. At 90 days, patients undergoing revisional surgery experienced overall complications (7.1% [21] vs 2.0% [12], P = .003), and Clavien-Dindo 3B complications (1.0% [3] vs 0, P = .037) more frequently, with intra-abdominal abscess washout being the most common Clavien-Dindo 3B complication.

Conclusions: Revisional surgery results in similar total complications at 30 days, but additional complications can occur out to 90 days.

Keywords: hiatal hernia surgery; morbidity; mortality; redo fundoplication; redo hiatal surgery; revision hiatal surgery.

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Conflict of interest statement

Conflict of Interest Statement Dr Louie discloses relationships with Implantica (Reflux Stop), consultant, and Aplos Medical (Omega Cuff), member, Data and Safety Monitoring Board. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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