[Refundoplication for failed antireflux surgery. Experience in sixteen cases]

We undertook this study to identify the main causes leading to a failed funduplication and to determine the feasibility and effectiveness of reoperation by laparoscopic approach.

A retrospective and descriptive study was carried out with a review of patient charts. Patients were reoperated for failed antireflux surgery between January 1999 and September 2004.

Sixteen patient charts were reviewed, 10 men (62.5%) and 6 women (37.5%), average age 42.1 +/- 15.4 years (21 to 72 years). Main preoperative symptoms were severe reflux in seven patients (43.7%), severe dysphagia in five (31.3%), and dysphagia and pain in four (25%). Thirteen patients (81%) had previous Nissen laparoscopic funduplication (NL), one (6%) open Nissen (ON) and two (13%) open Toupet (OT). Four patients were reoperated with open surgery (two Nissen and two Toupet), and 12 laparoscopically (11 Nissen and 1 Toupet). The main causes of dysfunction were a) in LN: sliding of the funduplication in five patients (38%), angulation of the funduplication in three (23%) and others; b) in ON: sliding of the funduplication in one patient; and c) in OT: posterior sliding of the funduplication in two cases. The hospital stay for the laparoscopic group was 3.5 +/- 1 days (2 to 5 days) and for the open group, 5.2 +/- 1.3 days (4 to 7 days, p < 0.013, Student t-test). Morbidity 1 month postoperatively was 37.5%. Also reported were abdominal distention (19%), occasional distention with dysphagia (12%), reflux (6.5%), with 0% mortality.

Laparoscopic reoperation for failed antireflux surgery is feasible with an acceptable morbidity and good results.