Laparoscopic revision surgery for gastroesophageal reflux disease

Abstract

Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases.From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated.The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers.

Additional fundophrenicopexia, after Nissen fundoplication, reduces postoperative dysphagia and re-operation rate in the long-term follow up

“…These results are also similar to previous literature showing revision rates from 3 – 6%, or in long-term follow-up from 5 – 15%. [ 43 , 44 ] Interestingly, when looking closer at our group with division of the SGV and comparing the two subgroups with patients undergoing additional fundophrenicopexia and those without, we found a significant difference in the revision rate between the patients (1 group B vs. 7 group A, p = 0.017). The most common cause for reoperation were fundoplication wrap disorders: re-herniation, slipping and disruption ( n = 4/7, 60%).…”

Influence of Wrap Fixation Technique on the Results of Fundoplication

“…In cases due to slippage of the wrap, most commonly it is manifested by severe reflux and dysphagia, which tends to occur due to part of the stomach being above the fundoplication wrap acting as a reservoir and overflowing with gastric contents during food intake. 14 Celasin et al 6 conducted a study evaluating the conditions necessitating redo antireflux surgery. It was established that in 7% of cases redo operations are performed secondary to a slipped wrap.…”

Recurrent hiatal hernias. To operate or not?

“…Важна и техническая сложность подобных вмешательств, определяющая более высокий риск серьезных, в том числе угрожающих жизни, осложнений. Все перечисленные условия в итоге и определяют высокую частоту неудовлетворительных результатов хирургического лечения рецидивных хиатальных грыж, достигающую в отдельных исследованиях 70-90 % [2, 4, 5,7,8,12].…”