Secondary antireflux surgery

ABSTRACT

With the introduction of laparoscopy, the number of antireflux surgeries [ARS], and consequently failed fundoplication, had increased many folds. We report the mechanisms of fundoplication failure in patients having ARS, and present our experience in surgical correction of such failure. Twenty three patients who had failed fundoplications were reoperated. Pre-and postoperative evaluation of patients included symptom severity endoscopy, barium study, esophageal motility and 24-hour pH metry. The initial procedures were Nissen in 13, Toupet in 8, and Nissen-Rossetti in 2 patients. The causes of failure were transdiaphragmatic migration of fundoplications [n=6], disrupted fundoplications [n=5], tight fundoplications [n=4], slipped/misplaced fundoplications [n=3], paraesophageal herniation [n=3], and tight crural repair [n=2]. The secondary ARS performed were Nissen [n=12], Toupet [n=7], paraesophageal hernia repair with crural repair [n=2], widening of tight crural repair [n=1], and taking down fundoplications [n=1]. Per-[n=4] and postoperative [n=5] complications were minor with no mortality. At follow-up, symptoms were significantly improved. Reoperations for failed ARS may be performed safely with excellent results. Proper patient selection and paying attention to some technical dnils at initial ARS could safe the patient another surgery