Esophagectomy after anti-reflux surgery.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Esophageal Surgery

Background:

• Limited data exists on the impact of prior fundoplication on subsequent esophageal resection.
• Fundoplication is a common anti-reflux procedure, and its influence on esophagectomy outcomes requires investigation.

Purpose of the Study:

• To evaluate the outcomes of esophagectomy in patients with a history of prior fundoplication.
• To compare complication rates, anastomotic leaks, and reoperation needs between patients with and without prior anti-reflux surgery.

Main Methods:

• Retrospective review of 2313 esophageal resections performed between 1988 and 2008 at Mayo Clinic.
• Comparison of 80 patients with prior fundoplication against a matched control group undergoing esophagectomy alone.

Main Results:

• Patients with prior anti-reflux surgery had significantly higher rates of postoperative complications (62.5%), anastomotic leaks (21.5%), and reoperations (20%).
• Indications for esophagectomy included benign stricture/perforation (41), cancer (28), and dysplasia (11).
• The stomach was the most common conduit (70 patients), and operative mortality was 3.7%.

Conclusions:

• Esophagectomy following anti-reflux surgery presents significant challenges.
• While the stomach is a viable conduit, patients with prior fundoplication face increased risks of postoperative complications, anastomotic leaks, and reoperation.