Re-do operations for failed anti-reflux surgery

ABSTRACT

Advances in the classical operations for gastroesophageal reflux disease [GERD] and the recent application of laparoscopic fundoplication have led to dramatic increase in the number of patients undergoing such operations and consequently their complications. To define the common technical defects responsible for failed operations for gastro-esophageal reflux disease [GERD] and how to manage such failures. This study included 17 patients who were reoperated upon for complications that developed after fundoplication done for treatment of gastro-esophageal reflux disease. The study was carried out at La Cavale Blanche Hospital, Brest University [France] and El Demerdash Hospital, Ain Shams University [Egypt] between November 97 and March 2000. Most of the post fundoplication complications were due to tight crurae [41.2%] and torsion of the lower esophagus [23.5%]. Rare causes were slipped stomach [11.8%], complete disruption of the wrap [5.9%], intrathoracic migration of the stomach [5.9%] and long wrap [5.9%]. In one patient, no operative abnormalities were detected. Operative management of these complications was presented. The major side effects of fundoplication can be minimized with further patient selection and attention to technical details in the construction of the wrap. Results of redo operations for failed anti-reflux procedures are encouraging for patients who are profoundly affected in their daily activities and their ability to lead a full and productive life