Reoperations After Complications or Failure of Antireflux Surgery

Ancona, Ermanno; Zaninotto, Giovanni; Costantini, Mario; Merigliano, Stefano; Baessato, M.; Peracchia, A.

doi:10.1007/978-3-642-86432-2_272

Cited by 2 publications

(7 citation statements)

References 2 publications

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“…As the frequency of surgical treatment through the laparoscopic route increases, and especially when this procedure is not performed by qualified surgeons, recurrence of gastroesophageal reflux also increases. 11,31,32,[35][36][37][38][39][40][41][42][43] 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.…”

Section: Discussionmentioning

confidence: 99%

“…These operations involve a major surgery, with increased morbidity and mortality, and the functional results are not really satisfactory. [82][83][84][85]…”

Section: Discussionmentioning

confidence: 99%

“… The wrong diagnosis is made of the pathophysiological factors involved, including failure of the sphincter mechanism, motility disorders, and duodenal reflux, all of which have a very direct association with the genesis of Barrett's esophagus and its complications. In addition, nearly 10% of patients have other associated gastrointestinal disturbances 33–39 The wrong surgical procedure is chosen or it is wrongly performed.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors suggest that in more than 50% of cases failure of surgical treatment is due to technical errors or complications after the procedure, such as slipped, disrupted, or redundant wrap, or the occurrence of postoperative hiatal hernia. As the frequency of surgical treatment through the laparoscopic route increases, and especially when this procedure is not performed by qualified surgeons, recurrence of gastroesophageal reflux also increases 11,31 , 32,35–43 …”

Section: Discussionmentioning

confidence: 99%

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Results of surgical treatment for recurrent postoperative gastroesophageal reflux

Braghetto¹,

Csendes²,

Burdiles³

et al. 2002

Diseases of the Esophagus

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The rate of recurrence of reflux esophagitis after classic antireflux surgery (fundoplication) is 10-15%. This rate is different in patients with esophagitis with and without Barrett's esophagus. We evaluated the clinical and laboratory findings in 104 patients with postoperative recurrent reflux esophagitis, determining the results of repeat antireflux surgery or an acid suppression-bile diversion procedure. Repeat fundoplication was performed in 26 patients, and truncal vagotomy, antrectomy, and Roux-en-Y gastrojejunostomy in 78 patients. Esophagectomy as a third operation was performed in seven patients. After repeat antireflux surgery, endoscopic evaluation demonstrated improvement of esophagitis in a small proportion of patients. Barrett's esophagus remained unchanged, and no regression of ulcer or stricture was observed. These complications improved significantly after acid suppression-bile diversion surgery. Incompetent lower esophageal sphincter (LES) was present in 55.8% after initial surgery and in 23% after reoperation. Acid reflux, initially present in 94.6% of patients, was also observed in 93.6% after fundoplication, 68.8% after redo fundoplication, and 16.6% after treatment with the acid suppression-bile diversion technique. A positive Bilitec test was present in 78% of patients before the operation and 56.6% after the repeat operation, and was negative after bile diversion surgery. Among 13 patients (50%) submitted to repeat surgery alone, esophagectomy as a third operation was necessary as a result of severe non-dilatable stricture in seven patients. Our conclusions are that repeat antireflux surgery alone failed to improve Barrett's esophagus complications and that the best results were obtained in patients submitted to acid suppression-bile diversion surgery.

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Section: Discussionmentioning

confidence: 99%

“…These operations involve a major surgery, with increased morbidity and mortality, and the functional results are not really satisfactory. [82][83][84][85]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

Braghetto¹,

Csendes²,

Burdiles³

et al. 2002

Diseases of the Esophagus

View full text Add to dashboard Cite

show abstract

“…For patients with severe recurrent reflux esophagitis, other authors have suggested performing sub total gastrectomy with Y-en-Roux diversion with or with out recalibration in order to prevent acid and alkaline reflux [30][31][32][33][34][35][36]. Recently we emphasized these indications for this procedure in agreement with other previous publi cations [30][31][32][33][34][35][36], In fact, our early clinical results agree with this hypoth esis because the best results were obtained in patients sub mitted to this type of operation. We think that esophagec tomy with esophageal replacement is only indicated in cases with a critically damaged esophagus (long and criti-cal strictures, or penetrating esophageal ulcer, severe mo tility disorders).…”

Section: Resultsmentioning

confidence: 99%

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

Braghetto¹,

Csendes²,

Nava³

et al. 1993

Dig Surg

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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.

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Reoperations After Complications or Failure of Antireflux Surgery

Cited by 2 publications

References 2 publications

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

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

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