[Reoperations in gastroesophageal reflux disease]

The purpose was to determinate the indications in which the failure of the surgical treatment of the gastroesophageal reflux disease (GERD) is more frequent and to analyze the results of the reinterventions.

We made a restrospective review of the patients who underwent reoperation at our Institution during 1992-2006.

19 of 252 Nissen underwent reoperation. In one case was the fourth fundoplication, in another was the third and the second in the rest of them. The reflux was confirmed by upper gastrointestinal contrast study, endoscopy, pH monitoring and, in some cases, manometry. 5 cases have surgical comorbidity (3 Esophageal Atresia (EA), 2 Congenital diaphragmatic hernia (CDH), 4 patients was neurologically impaired, 1 had caustic stenosis (CS), and 9 only symptoms of GERD. 8.7% of the patients with GERD, 5.8% of the neurologically impaired children, 10% of the EA, 20% of the CDH and 50% of the CS underwent redo Nissen. The mean time between first and second fundoplication was 1.6 years (range = 1 m-5.5 y). It was 11.2 in neurologically impaired patients, 5 m in CS, 11.5 m in CDH, 2.4 y in EA and 2.8 y in the rest. In patients with respiratory disease, the mean was 1.1 y and 1.9 y in the rest. The mechanism of failure was herniation of the fundoplication through the hiatus in 8 cases, wrap incompetence in 4 and wrap dehiscence in 2. In 5 patients it couldn't be determined. There were 2 postoperative complications. The mean follow-up was 5.3 years (range = 6-151.5 m). There was no cases of mortality. 17 of the 19 patients (89.4%) are free of symptoms and don't need more treatments. The child with CS continuous periodic esophageal dilatations and 1 of the patients with EA has dysphagia to solid foods.