Perioperative outcomes of surgical procedures for symptomatic fundoplication failure: a retrospective case–control study

Abstract

Compared to primary antireflux surgery, revisional operations are associated with longer mean operating times, increased length of hospital stay, and increased morbidity. Despite this fact, the majority of patients are satisfied with the outcomes of revisional surgery for failed fundoplication, and symptomatic outcomes are good.

Clinical Outcomes of Reoperation for Failed Antireflux Operations

“…This reduction in QOL is potentially likely due to further alterations in the local anatomy and deterioration in esophageal function. These findings are similar to those by Musunuru and Gould [11], who compared laparoscopic reoperative ARS vs controls and confirmed that Visick and satisfaction scores are lower in the reoperative group, and to the study by Little and colleagues [7] that showed worse outcomes with open operations in patients undergoing two or more operations. These results suggest that procedures other than an antireflux operation should be considered if an initial reoperation fails.…”

“…The rate of reoperation (8%) and the predominant type of failure is similar to other studies [4,6,8,11]. Although often difficult to ascertain, failure of the hiatal closure appears to be a large contributor to most ARS failures.…”

“…These results suggest that procedures other than an antireflux operation should be considered if an initial reoperation fails. A REY reconstruction has been suggested and, arguably, is a good choice, particularly in patients who are obese, have decreased esophageal motility, or a short esophagus [11,19]. Recent studies report that patients who undergo REY after failed fundoplication have excellent symptomatic control of reflux, excellent QOL, and high rates of satisfaction with their outcome [18,20].…”

“…Even though safe and effective, morbidity rates are reported to be higher [8]. Several authors have also cautioned that each additional reoperation results in fewer patients achieving a satisfactory-to-excellent outcome [7,[9][10][11]. However, these clinical reports rarely have a comparison group of patients who underwent a successful primary repair [11].…”

“…Several authors have also cautioned that each additional reoperation results in fewer patients achieving a satisfactory-to-excellent outcome [7,[9][10][11]. However, these clinical reports rarely have a comparison group of patients who underwent a successful primary repair [11]. The lack of comparative data encouraged us to compare the clinical outcomes and quality of life (QOL) in patients who underwent reoperation for failed ARS with those who had a successful initial operation.…”