Reoperations for esophagitis following failed antireflux procedures

Abstract

During the last 20 years, several procedures have been introduced that effectively control gastroesophageal reflux. Nevertheless, little has been written regarding surgical management of patients with recurrent esophagitis following a failed antireflux procedure. The purpose of this study was to review the results of all operations for recurrent esophagitis. Fifty-five patients had undergone a total of 61 previous operations for reflux (initial operation: Hill, nine; Nissen, 30; Allison, eight; Thal, patch three; Belsey, 10; other, one). Eleven patients underwent a Hill procedure (indications: intractable "gas-bloat" syndrome, 4 patients, esophagitis, 7 patients). Two developed recurrent esophagitis (18%). Seventy-eight per cent had satisfactory results (mean follow-up 24 months), and there were no deaths. Three individuals had a transabdominal fundoplication. One patient was lost to follow-up while the other two had satisfactory results (follow-up, 1 and 6 years). Twenty-nine patients were subjected to a transthoracic fundoplication, with two deaths (seven per cent). One patient (four per cent) was lost to follow-up at 9 months; mean follow-up was 44 months). Eighty-six per cent had satisfactory results. The sole poor result occurred in a scleroderma patient who ultimately required colon interposition. Twelve patients underwent a Thal-Nissen procedure. One patient was lost to follow-up (eight per cent), while another with scleroderma had an unsatisfactory result (eight per cent); 83% had satisfactory results. The mean follow-up was 70 months. There were no deaths. Overall, 80% of patients subjected to reoperation had satisfactory results. Mortality was four per cent. Reoperations for gastroesophageal reflux constitute an effective means of controlling recurrent esophagitis and compare favorably with primary operations in both mortality and success rate.