 |
|
Failed Antireflux Surgery
What Have We Learned From Reoperations?
Santiago Horgan, MD;
Dieter Pohl, MD;
Diego Bogetti, MD;
Thomas Eubanks, DO;
Carlos Pellegrini, MD
Arch Surg. 1999;134:809-817.
Hypothesis Factors that lead to failures in antireflux procedures can be identified, and dealing with them at the initial operation may decrease the number of such failures.
Design Analysis of symptoms, 24-hour esophageal pH monitoring, manometry, upper gastrointestinal tract radiographs, and correlation with operative anatomic findings.
Setting University referral center.
Patients Forty-eight patients who previously underwent antireflux surgery (Nissen fundoplication, 29; Hill fundoplication, 7; Angelchik prosthesis, 1; multiple, 5; unknown, 6) and had symptoms of foregut disease.
Main Outcome Measures Determination of the cause of failure of previous operations and identification of factors that may prevent recurrence.
Results Fourteen patients (29%) presented with symptoms of an incompetent cardia (heartburn and regurgitation), 15 patients (31%) presented with symptoms of defective esophageal emptying (dysphagia), 13 (27%) had symptoms of both, and 6 (13%) had other symptoms. All patients were initially treated medically and/or with dilation. A reoperation was performed in 31 patients (65%) whose symptoms persisted. Reoperation was completed laparoscopically in 28 patients (90%). At reoperation we identified 3 main types of failure: type I, patients in whom the gastroesophageal junction was herniated through the hiatus, either with the wrap (IA) or without it (IB). There were 13 patients (43%) classified as having type IA, and 5 patients (16%) classified as having type IB. Type II failure involved a paraesophageal component resulting from a redundant wrap in 5 patients (16%), and type III involved a malformation (defective position or construction) of the wrap in 2 patients (6%). The remainder had a failed Hill fundoplication (3 patients), a herniated Angelchik prosthesis (1 patient), and normal postoperative anatomy (2 patients).
Conclusions Failure of the crural closure and malformation of the wrap are the main reasons for failure of antireflux procedures. Use of proper surgical techniques including meticulous closure of the crura and appropriate construction and fixation of the wrap at the first operation will help prevent recurrence.
From the Department of Surgery, University of Washington Medical Center, Seattle.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Long-term results of redo gastro-esophageal reflux disease surgery
Avaro et al.
Eur. J. Cardiothorac. Surg. 2008;33:1091-1095.
ABSTRACT
| FULL TEXT
Surgical Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease: A Prospective Cohort Study in 130 Patients--Invited Critique
Pellegrini
Arch Surg 2008;143:274-274.
FULL TEXT
Laparoscopic Antireflux Surgery: Five-Year Results and Beyond in 1340 Patients
Pessaux et al.
Arch Surg 2005;140:946-951.
ABSTRACT
| FULL TEXT
Laparoscopic Nissen Fundoplication With Prosthetic Hiatal Closure Reduces Postoperative Intrathoracic Wrap Herniation: Preliminary Results of a Prospective Randomized Functional and Clinical Study
Granderath et al.
Arch Surg 2005;140:40-48.
ABSTRACT
| FULL TEXT
Reoperative laparoscopic fundoplication for the treatment of failed fundoplication
Papasavas et al.
J. Thorac. Cardiovasc. Surg. 2004;128:509-516.
ABSTRACT
| FULL TEXT
Laparoscopic Refundoplication With Prosthetic Hiatal Closure for Recurrent Hiatal Hernia After Primary Failed Antireflux Surgery
Granderath et al.
Arch Surg 2003;138:902-907.
ABSTRACT
| FULL TEXT
Outcomes after minimally invasive reoperation for gastroesophageal reflux disease
Luketich et al.
Ann. Thorac. Surg. 2002;74:328-332.
ABSTRACT
| FULL TEXT
Is the Use of a Bougie Necessary for Laparoscopic Nissen Fundoplication?
Novitsky et al.
Arch Surg 2002;137:402-406.
ABSTRACT
| FULL TEXT
Management and Outcome of Complications After Laparoscopic Antireflux Operations
Pohl et al.
Arch Surg 2001;136:399-404.
ABSTRACT
| FULL TEXT
|
