Revisional surgery after failed laparoscopic anterior fundoplication

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Partial fundoplication, while potentially offering functional benefits, presents a more complex reconstruction compared to circumferential wraps.
• Revisional surgery for persistent or recurrent gastroesophageal reflux disease (GERD) after initial fundoplication can be challenging due to prior surgical alterations.
• Laparoscopic anterior fundoplication involves specific suturing techniques that may influence the complexity of subsequent revisional procedures.

Purpose of the Study:

• To evaluate the safety and outcomes of revisional surgery in patients who previously underwent laparoscopic anterior fundoplication and hiatal repair for GERD.
• To identify common causes for revisional surgery after laparoscopic anterior fundoplication.
• To assess patient satisfaction and functional outcomes following repeat anti-reflux procedures.

Main Methods:

• A retrospective analysis of 11 patients (3.5% of 309) requiring revisional surgery after laparoscopic anterior fundoplication between 1993 and 1999.
• Data collection involved a prospective database and a postal questionnaire assessing outcomes after the second operation.
• Revisions were performed either laparoscopically (10 cases) or via open surgery (1 case).

Main Results:

• The primary indications for revisional surgery included posterior hiatal disruption (9 cases), anterior paraesophageal hernia (1 case), and inadequate initial esophageal mobilization (1 case).
• Laparoscopic revision was successfully performed without conversion to open surgery in all 10 laparoscopic cases.
• A significant majority (91%) of patients reported a good or excellent outcome after the repeat procedure, with all patients recommending it for similar symptoms.

Conclusions:

• Revisional surgery following laparoscopic anterior fundoplication is a safe and effective treatment option for patients with recurrent GERD.
• The study highlights the potential for good patient outcomes and high satisfaction rates after repeat anti-reflux surgery.
• Modifications in both primary and revisional surgical techniques may be beneficial in reducing the incidence of early technical failures and the need for reoperation.