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Myriam J. Curet, MD, FACS; Robert K. Josloff, MD; Othmar Schoeb, MD; Karl A. Zucker, MD

Arch Surg. 1999;134:559-563.

Background  Laparoscopic fundoplication has become the criterion standard for the surgical treatment of gastroesophageal reflux disease. Recently, several patients were referred with recurrent symptoms of gastroesophageal reflux disease or severe dysphagia following previous antireflux surgery for possible laparoscopic reoperation.

Hypothesis  To determine the safety and efficacy of this procedure.

Design  Case series, consecutive sample.

Setting  University-affiliated and community tertiary care hospitals.

Patients  Prospective study of 27 consecutive patients undergoing attempted laparoscopic reoperation for symptoms of recurrent gastroesophageal reflux disease or intractable dysphagia following antireflux surgery. Patients were available for follow-up for 1 to 60 months postoperatively.

Interventions  All patients underwent preoperative workup and attempted laparoscopic reoperation for treatment of symptoms.

Main Outcome Measures  Data were collected on preoperative symptoms and evaluation, operative time, blood loss, time to regular diet, length of hospitalization, morbidity, mortality, and long-term results.

Results  Twenty-six patients underwent successful laparoscopic operations, with no mortality and minimal morbidity. One patient underwent conversion to open laparotomy and then developed a proximal gastric leak, which was treated conservatively. Twenty-four patients began a liquid diet by postoperative day 1, and most were discharged from the hospital by postoperative day 3. One patient required dilation for postoperative dysphagia. The remaining patients are doing well and none have required treatment with acid-reducing medication.

Conclusions  Although technically challenging, laparoscopic reoperation for recurrent gastroesophageal reflux disease can be performed safely and with excellent results. In the hands of experienced endoscopic surgeons, patients who have undergone unsuccessful antireflux surgery should be offered laparoscopic reoperation.

From the Department of Surgery, University of New Mexico School of Medicine, Albuquerque (Dr Curet); Abington Memorial Hospital, Abington, Pa (Dr Josloff); the Department of Surgery, University of Zurich, Zurich, Switzerland (Dr Schoeb); and the University of Arizona School of Medicine, Phoenix (Dr Zucker).

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