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Laparoscopic reoperative antireflux surgery
Z T Awad1, P I Anderson, K Sato
1Department of Surgery, Suite 3740, Creighton University School of Medicine, 601 N. 30th Street, Omaha, NE 68131, USA.
Surgical Endoscopy
|April 20, 2002
Summary
Laparoscopic reoperation for failed antireflux surgery offers a feasible solution for gastroesophageal reflux disease recurrence. This minimally invasive approach shows acceptable preliminary outcomes for patients needing revision surgery.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Antireflux operations for gastroesophageal reflux disease (GERD) can fail, necessitating reoperation due to symptom recurrence or complications.
- Laparoscopic reoperation is explored as a solution for patients with previously failed anti-reflux procedures.
Purpose of the Study:
- To evaluate the feasibility and preliminary outcomes of laparoscopic reoperative antireflux procedures.
- To analyze patient demographics, presenting symptoms, and surgical approaches in reoperative GERD surgery.
Main Methods:
- A cohort of 37 patients undergoing laparoscopic reoperative antireflux procedures between 1995 and 2000 was analyzed.
- Procedures included Nissen fundoplication (n=27) and Toupet fundoplication (n=9), with 86.5% completed laparoscopically.
- Patient data included age, weight, presenting symptoms (heartburn, respiratory reflux, chest pain, regurgitation, dysphagia), and timing of recurrence.
Main Results:
- Intraoperative and postoperative complications occurred in 6 and 14 patients, respectively.
- Fundoplication disruption was identified as the primary cause of initial surgery failure.
- At a mean follow-up of 26.5 months, 65% of patients had excellent to good outcomes, 21.5% fair, and 13.5% poor.
Conclusions:
- Laparoscopic reoperative antireflux surgery is technically feasible for managing failed primary procedures.
- The approach demonstrates acceptable preliminary results for patients experiencing recurrent GERD symptoms after initial surgery.