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A Prospective Cohort Study in 130 Patients

Edgar J. B. Furnée, MD; Werner A. Draaisma, MD, PhD; Ivo A. M. J. Broeders, MD, PhD; Andre J. P. M. Smout, MD, PhD; Hein G. Gooszen, MD, PhD

Arch Surg. 2008;143(3):267-274.

Hypothesis  Surgical reintervention after antireflux surgery for gastroesophageal reflux disease is required in 3% to 6% of patients. The subjective outcome after reintervention has been reported in several studies, but objective results after these subsequent operations have rarely been published. The purpose of this study was to assess the symptomatic and objective outcomes in patients who underwent subsequent operation because of recurrent reflux symptoms or troublesome dysphagia after primary antireflux surgery.

Design  Prospective cohort study.

Setting  University medical center.

Patients  Between January 1, 1994, and March 31, 2005, 130 patients (mean [SD] age, 48.4 [14.1] years) undergoing surgical reintervention after antireflux surgery for gastroesophageal reflux disease were prospectively studied.

Main Outcome Measures  Symptomatic outcome was determined by questionnaires. Esophageal manometry and 24-hour pH monitoring were performed to assess the objective outcome.

Results  A total of 144 reinterventions were performed in 130 patients, for recurrent reflux in 94 patients (65.3%) and for troublesome dysphagia in 50 patients (34.7%). Belsey Mark IV fundoplication through a left-sided thoracotomy was performed in 78 (54.2%) and a subsequent Nissen or partial fundoplication during 66 reinterventions (45.8%), including 16 laparoscopic procedures. After a mean (SD) follow-up of 60.1 (37.2) months, symptoms were absent or significantly improved in 70.3% of patients and esophageal acid exposure was normalized in 70.2% of patients after surgery. Postoperative complications occurred after 14 subsequent operations (9.7%).

Conclusions  Surgical reintervention after antireflux surgery for gastroesophageal reflux disease yielded good symptomatic and objective results in 70% of patients in this prospective cohort study. Since the morbidity of this type of surgery is far from negligible, the expectations should be discussed in detail before additional operation.

Author Affiliations: Gastrointestinal Research Unit, Departments of Surgery (Drs Furnée, Draaisma, Broeders, and Gooszen) and Gastroenterology (Dr Smout), University Medical Center Utrecht, Utrecht, the Netherlands.

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Surgical Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease: A Prospective Cohort Study in 130 Patients—Invited Critique
Carlos A. Pellegrini
Arch Surg. 2008;143(3):274.
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