Reoperative laparoscopic antireflux surgery

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Gastroesophageal reflux disease (GERD) often requires surgical intervention.
• Laparoscopic antireflux surgery (LAP) is a common treatment for refractory GERD.
• Recurrent GERD and postfundoplication complications necessitate reoperative strategies.

Purpose of the Study:

• To evaluate the effectiveness of remedial laparoscopic antireflux surgery (LAP).
• To assess the utility of repeat LAP for managing recurrent GERD after initial antireflux procedures.
• To determine if LAP can address postfundoplication complications like dysphagia and gas bloat.

Main Methods:

• A cohort of 15 patients with recurrent GERD or postfundoplication issues underwent remedial LAP.
• Procedures included conversion from Nissen to Toupet fundoplication and revision of prior antireflux repairs.
• Patients had prior LAP (n=8) or open antireflux surgery (n=1).

Main Results:

• Remedial LAP was successfully performed in all 15 patients.
• Intraoperative findings included disrupted, incomplete, or malpositioned fundoplications, and paraesophageal hernias.
• Significant improvement in dysphagia, heartburn, gas bloat, and regurgitation scores was observed post-surgery (P < .05).
• GERD testing normalized in 13 of 15 patients post-procedure.

Conclusions:

• Reoperative antireflux surgery via LAP is feasible without compromising therapeutic goals or increasing morbidity.
• Experienced surgeons can consider repeat LAP for recurrent GERD or postfundoplication problems.
• LAP offers a viable alternative to open surgery for complex antireflux cases.