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Surgical management after failed antireflux operations.

D B Skinner1

  • 1New York Hospital, Cornell Medical Center, New York 10021.

World Journal of Surgery
|March 1, 1992
PubMed
Summary

Re-operation for failed antireflux surgery is common, with specific classifications aiding treatment. Understanding the cause of failure, like sphincter or clearance issues, guides re-operation strategies for better outcomes.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Patient Outcomes

Background:

  • Gastro-esophageal reflux disease (GERD) management often involves surgical intervention.
  • Antireflux surgery can fail, necessitating re-operation in a significant patient subset.
  • Identifying reasons for surgical failure is crucial for optimizing subsequent treatment.

Purpose of the Study:

  • To classify patients undergoing re-operation for failed antireflux surgery.
  • To evaluate the long-term outcomes of re-operative procedures.
  • To determine if a classification system can guide re-operation strategies.

Main Methods:

  • Retrospective review of 78 patients who underwent re-operation for failed antireflux surgery before 1984.
  • Detailed pre-operative evaluation including symptom scores, radiography, endoscopy, and esophageal function tests.
  • Classification of failure into categories: sphincter mechanism failure, esophageal clearance failure, combined, alkaline reflux, or other conditions.

Main Results:

  • 117 (28%) of 413 patients required re-operation for failed antireflux surgery between 1973-1989.
  • Failure classifications included: sphincter mechanism failure (n=14), clearance failure (n=12), combined (n=29), alkaline reflux (n=9), and other (n=14).
  • Patients with prior Nissen fundoplication or Angelchik prosthesis were more prone to esophageal clearance failure.

Conclusions:

  • A detailed classification system for failed antireflux surgery is effective in guiding re-operation.
  • Identifying the specific failure mechanism (sphincter vs. clearance) is key to successful re-intervention.
  • Re-operation for GERD carries risks, with 1.7% mortality and 21% complications observed in this cohort.

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