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When fundoplication fails: redo?

C Daniel Smith1, David A McClusky, Murad Abu Rajad

  • 1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. csmit27@emory.edu

Annals of Surgery
|May 25, 2005
PubMed
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Redo fundoplication is successful in 93% of patients, with most failures occurring within two years due to wrap herniation. Experienced surgeons can safely perform these procedures laparoscopically.

Area of Science:

  • Gastroenterology
  • Surgical Procedures
  • Gastroesophageal Reflux Disease (GERD) Management

Background:

  • Esophagogastric fundoplication failure necessitates redo procedures, but data on failure mechanisms are limited.
  • This study updates the largest series on redo fundoplication, including 307 patients.

Purpose of the Study:

  • To analyze the outcomes and failure mechanisms of redo fundoplication.
  • To assess the success rate and safety of laparoscopic redo fundoplication.

Main Methods:

  • Prospective data collection for foregut surgery patients from 1991 to 2004.
  • Analysis of 307 patients undergoing redo fundoplication for anatomic complications or recurrent GERD.
  • Statistical analysis using chi-squared, Mann-Whitney U, and ANOVA.

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Main Results:

  • Redo fundoplication was required in 2.8% of primary fundoplications.
  • Most failures (73%) occurred within 2 years, with transdiaphragmatic wrap herniation being the most common cause (61%).
  • Redo fundoplication achieved a 93% success rate, with 78% of procedures initiated laparoscopically.

Conclusions:

  • Fundoplication failure is uncommon in experienced hands, with wrap herniation as the leading cause for redo.
  • Redo fundoplication is highly successful and can be safely performed laparoscopically.
  • Most failures are addressed within two years of the initial surgery.