Clinical Outcomes of Reoperation for Failed Antireflux Operations

Wilshire, Candice L.; Louie, Brian E.; Shultz, Dale; Jutric, Zeljka; Farivar, Alexander S.; Aye, Ralph W.

doi:10.1016/j.athoracsur.2015.10.027

Cited by 30 publications

(11 citation statements)

References 28 publications

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“…Failure after the first redo-fundoplication is 12-20% and reaches 40% in cases submitted to a second redo. The worst results have been reported in obese or Barrett´s esophagus patients 7 , 20 , 25 , 41 , 49 , 50 , 51 .…”

Section: Discussionmentioning

confidence: 96%

“…The postoperative complications range from 15-27% and a long hospital stay may be required (6-58 days). The success rate after the first re-fundoplication is very variable ranging from 42 to 94% and decreases to 60% after the second re-fundoplication 3 , 7 , 20 , 23 , 25 , 28 , 34 , 35 , 45 , 46 , 51 , 52 , 53 . In addition, studies addressing long term outcomes have observed 27 to 41% of reflux recurrence with incomplete relief of symptoms in 12-50% of patients submitted to re-fundoplication.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is possible to postulate that the combination of both procedures could be the best choice in order to avoid acid and bile reflux. The disadvantage of this alternative is the high rate of in-hospital or postoperative morbidity which can reach up to 67% after gastrectomy compared to only 20% after refundoplication (p=0.007) 10 , 12 , 31 , 33 , 37 , 45 , 47 , 49 , 51 . On the other hand, the advantage of distal gastrectomy is relief of reflux symptoms after surgery, which reach nearly 89% compared to 50% after refundoplication (p=0.044).…”

Section: Discussionmentioning

confidence: 99%

“…The mean reported failure after fundoplication is nearly 18% (3-33%) associated with recurrent reflux symptoms or erosive esophagitis, and 4.5-20% of these patients need re-operation 5 , 20 , 21 , 29 , 51 , 52 . The reported failure in non-Barrett´s patients is 5-12% and in Barrett´s failure is observed three times more frequently, from 12 to 39%.…”

Section: Introductionmentioning

confidence: 99%

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Failure After Fundoplication: Re-Fundoplication? Is There a Room for Gastrectomy? In Which Clinical Scenaries?

Braghetto

Csendes

2019

ABCD, arq. bras. cir. dig.

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Background: Re-fundoplication is the most often procedure performed after failed fundoplication, but re-failure is even higher. Aim: The objectives are: a) to discuss the results of fundoplication and re-fundoplication in these cases, and b) to analyze in which clinical situation there is a room for gastrectomy after failed fundoplication. Method: This experience includes 104 patients submitted to re-fundoplication after failure of the initial operation, 50 cases of long segment Barrett´s esophagus and 60 patients with morbid obesity, comparing the postoperative outcome in terms of clinical, endoscopic, manometric and 24h pH monitoring results. Results: In patients with failure after initial fundoplication, redo-fundoplication shows the worst clinical results (symptoms, endoscopic esophagitis, manometry and 24 h pH monitoring). In patients with long segment Barrett´s esophagus, better results were observed after fundoplication plus Roux-en-Y distal gastrectomy and in obese patients similar results regarding symptoms, endoscopic esophagitis and 24h pH monitoring were observed after both fundoplication plus distal gastrectomy or laparoscopic resectional gastric bypass, while regarding manometry, normal LES pressure was observed only after fundoplication plus distal gastrectomy. Conclusion: Distal gastrectomy is recommended for patients with failure after initial fundoplication, patients with long segment Barrett´s esophagus and obese patients with gastroesophageal reflux disease and Barrett´s esophagus. Despite its higher morbidity, this procedure represents an important addition to the surgical armamentarium.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Failure After Fundoplication: Re-Fundoplication? Is There a Room for Gastrectomy? In Which Clinical Scenaries?

Braghetto

Csendes

2019

ABCD, arq. bras. cir. dig.

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“…3,4 However, revisional fundoplication is associated with a higher failure rate than primary fundoplication, with a risk of failure as high as 60 per cent at five years. 5,6 Moreover, patients undergoing revisional fundoplication face a higher rate of postoperative complications with each subsequent fundoplication. 7 A significant risk factor, which is likely the primary driver for the increased incidence of GERD in recent decades, is obesity.…”

mentioning

confidence: 99%

Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass

Spann

Harrison

English

et al. 2020

The American Surgeon™

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Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repairin regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018. The median operative time was 232 minutes with a median hospital length of stay of two days. The median length of follow-up was 24 months. Two patients (10.5%) had complications in the first 30 days, and five patients (26.3%) had complications within one year. Of the 12 patients on preoperative acid suppression, 6 (50%) were either off medication or on reduced dose at 12 months. The median BMI decrease was 14.4 kg/m2 at 12 months and did not change significantly afterward. Although rates of acid-suppression medication use did not change overall after revisional PEH repair with RYGB, patients experienced successful long-term management of morbid obesity and sustained weight loss. Revisional PEH repair with RYGB is a safe and effective option, with a complication rate comparable with the reported rates after revisional foregut procedures such as revisional Nissen fundoplication.

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