Clinical and Laboratory Characteristics and Surgical Alternatives in Patients with Postoperative Recurrent Reflux Esophagitis

Abstract

The recurrence of reflux esophagitis after antireflux surgery ranges between 5 and 25% according to the technique employed. The clinical, laboratory findings and the surgical alternatives were analyzed in patients with recurrent reflux esophagitis. Fifty-two patients were included in the study. All patients presented heartburn; 62% of them had a hypotensive lower esophageal sphincter and gastrophageal reflux was present in 97% of cases. Alkaline reflux was also assessed. Endoscopic results demonstrated severe esophagitis in about half the patients. Reoperations were performed 3 or more years after the first operation in almost 90% of cases. The patients were submitted to: recalibration of cardia with posterior gastropexy (19 patients); fun duplication (5 cases); partial distal gastrectomy with Roux-en-Y gastrojejunostomy (25 patients), and esophagectomy with colon interposition in 3 cases. Mortality was 5.8%. Despite the surgical difficulties and morbimortality rate after reoperation for failed antireflux surgery, this seems to be an alternative for recurrent reflux esophagitis in patients who have not responded to adequate medical treatment.

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

“…The symptoms of recurrence of gastroesophageal reflux are very similar to those leading to first surgery, and symptoms can recur very soon after the initial operation. Similar results concerning symptoms, laboratory findings, time to recurrence, and indications for reoperation have been presented by Hill et al ., 44 Watson et al ., 45 and others 31,46 , 47 …”

“…Similar results concerning symptoms, laboratory findings, time to recurrence, and indications for reoperation have been presented by Hill et al, 44 Watson et al, 45 and others. 31,46,47 Many patients with postoperative recurrence are treated with proton pump blockers, prokinetics, and other complementary drugs that are useful for control of symptoms. Nevertheless, various reports have reported a rate of recurrence of symptoms of more than 85%.…”

“…At long‐term follow‐up there is a high rate of recurrence of symptoms and esophagitis. Classical surgical techniques are not able to repair permanently the anatomic and functional alterations of the gastroesophageal sphincter and the gastroesophageal junction in patients with Barrett's esophagus 6,46 , 67,70 . This is why our preference has been to complement the antireflux procedure with bilateral truncal vagotomy and antrectomy with Roux‐en‐Y gastrojejunostomy, as in this way all the involved pathophysiological mechanisms are controlled.…”

Surgical Reintervention After Failed Antireflux Surgery: A Systematic Review of the Literature

“…Data were obtained by questionnaires in 29 studies (36.7%),8,10,11,16–18,20,22–24,27,28,30,34–37,42,45,46,48,49,54,55,61,69,71,80,84 by interview in 21 (26.6%),13,25,31,38,41,47,52,53,57,60,62,65–68,73,74,78,82,83,85 and this was not reported in the remaining 29 studies (36.7%) 12,14,15,21,26,32,33,39,40,43,44,50,51,56,58,59,63,64,70,72,75–77,79,81,86–89. The mean success rate in studies only reporting on laparoscopic reoperations (17 studies)11–13,23–25,28,31,35,39,41,48,50,53,61,70,85 was 84.2 ± 2.5% and 84.6 ± 3.4% in studies in which all reoperations were performed by a conventional abdominal approach (ten studies) 10,22,33,44,58,…”

“…The mean success rate in studies only reporting on laparoscopic reoperations (17 studies)11–13,23–25,28,31,35,39,41,48,50,53,61,70,85 was 84.2 ± 2.5% and 84.6 ± 3.4% in studies in which all reoperations were performed by a conventional abdominal approach (ten studies) 10,22,33,44,58,68,69,75,76,86. In patients in whom the reoperation was performed for symptoms only, 82.0 ± 10.7% had successful symptomatic outcome,47,79 and the success rate was 81.0 ± 12.1% in patients with recurrent reflux documented by pH monitoring 10,12,56,89. Comparing the outcome of total and partial refundoplication, Awad et al53 reported symptomatic success in 68% and 60% of patients, respectively.…”