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Is laparoscopic reoperation for failed antireflux surgery feasible?
N R Floch1, R A Hinder, P J Klingler
1Department of Surgery, Mayo Clinic, Jacksonville, Fla 32224, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|July 13, 1999
Summary
Laparoscopic reoperative surgery successfully treats failed antireflux procedures, most commonly caused by hiatal herniation or fundoplication breakdown. Patients reported significant improvement in well-being and satisfaction after these complex laparoscopic interventions.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Antireflux surgery is performed to treat gastroesophageal reflux disease.
- Failure of primary antireflux surgery can lead to persistent symptoms and necessitate reoperation.
- Identifying causes of failure is crucial for successful revision surgery.
Purpose of the Study:
- To evaluate the efficacy and safety of laparoscopic techniques for reoperative antireflux surgery.
- To determine the common causes of failed primary antireflux procedures.
- To assess patient satisfaction and outcomes following laparoscopic reoperation.
Main Methods:
- A case series study was conducted at two academic medical centers.
- Forty-six patients who underwent reoperative antireflux surgery were analyzed.
- Data collected included causes of failure, operative details, complications, and patient-reported outcomes.
Main Results:
- Hiatal herniation (67%) and fundoplication breakdown (43%) were the most frequent causes of antireflux surgery failure.
- Laparoscopic reoperative procedures included Nissen fundoplication, Toupet fundoplication, and paraesophageal hernia repair.
- Postoperative well-being scores significantly improved (P<.001), with 89% of patients satisfied with reoperation.
Conclusions:
- Failed antireflux surgery is often due to hiatal herniation or fundoplication issues.
- Laparoscopic reoperation is a viable and successful treatment option for patients with failed antireflux surgery.
- Despite technical challenges, good patient outcomes and satisfaction were achieved with the laparoscopic approach.