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Failed antireflux surgery: results after reoperation.
Galen A Ohnmacht1, Claude Deschamps, Stephen D Cassivi
1Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
The Annals of Thoracic Surgery
|May 30, 2006
Summary
Reoperation for failed antireflux surgery is safe and effective, regardless of the surgical approach used. This study found that most patients experienced significant improvement after revision surgery for recurrent GERD or hiatal hernia.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic antireflux surgery is common, but data on reoperation outcomes are limited.
- Failed antireflux procedures can lead to recurrent gastroesophageal reflux disease (GERD) or hiatal hernia, necessitating reoperation.
Purpose of the Study:
- To evaluate the safety and effectiveness of reoperation for failed antireflux surgery.
- To determine if the surgical approach or previous procedure type impacts reoperation outcomes.
Main Methods:
- Retrospective review of 124 patients undergoing reoperation for failed antireflux surgery (July 1995-April 2004).
- Initial operations included laparoscopic (61.3%) and open (38.7%) antireflux procedures.
- Reoperation approaches included thoracotomy (83), laparotomy (36), and laparoscopy (4).
Main Results:
- No operative deaths; 21.7% complication rate.
- Median hospitalization was 6 days.
- 91.9% of patients showed improvement, with 55.6% achieving excellent functional results.
Conclusions:
- Reoperation for failed antireflux surgery is a safe and effective treatment option.
- Outcomes were not influenced by the reoperation technique or the approach of the initial surgery (laparoscopic vs. open).