Re-operations for failed anti-reflux surgery. Lessons from the past and prospects for the future

The total number of re-operations for failed antireflux surgery is increasing dramatically worldwide. We reviewed our experience of re-operations for failed anti-reflux surgery to identify the factors contributing to unsuccessful re-operation which can be used in the era of laparoscopic surgery.

One hundred twenty one patients were re-operated. Only patients whose information responded to 16 variables were included. Those patients who underwent only 1 re-operation, formed group A, and those who had more than 1 re-operation were included in group B.

Seventy-seven patients entered the study. Fifty-eight patients were included in Group A and 19 in Group B. Thirty-five patients of Group A were male, whilst 12 of Group B were female. Dysphagia was the leading symptom in the 1st and subsequent re-operation. After the initial operation, 21 patients developed a symptom different from the main preoperative one. Nine of these (15%) were in group A, whilst 12 (63%) were in group B (p = 0.001). Intra-operative peri-esophageal fibrosis during the first re-operation was present in 18% of patients of group A, and 47% of group B (p = 0.01). The presence of an anatomical defect was most common in patients of group A (p = 0.02). Mean follow-up was 10.4 years with excellent/good results in 90% of the patients.

These findings will help in informing surgeons about the factors influencing the outcome of re-doing operations for failed anti-reflux surgery. Meticulous diagnosis and operative techniques may permit excellent/good results in this difficult group of patients.