Laparoscopic Nissen fundoplication after failed EsophyX fundoplication

Area of Science:

• Gastroenterology
• Surgical Innovation
• Reflux Disease Management

Background:

• Endoluminal EsophyX fundoplication is not always effective for gastro-oesophageal reflux disease.
• Laparoscopic Nissen fundoplication (LNF) may be necessary for persistent symptoms.
• Evaluating LNF outcomes after EsophyX failure is crucial.

Purpose of the Study:

• To assess the effectiveness of LNF in patients with failed EsophyX procedures.
• To analyze symptomatic and objective outcomes of LNF post-EsophyX.
• To identify risks associated with LNF after prior EsophyX.

Main Methods:

• Defined EsophyX failure by symptom recurrence, anatomical issues, or acid exposure.
• Identified patients undergoing LNF after EsophyX failure.
• Collected symptomatic data via questionnaires and objective data via endoscopy, manometry, and pH monitoring.

Main Results:

• Eleven patients were analyzed; two experienced intraoperative gastric perforation, and one developed a subphrenic abscess.
• One patient had daily heartburn, and three reported daily dysphagia post-LNF.
• Quality of life did not significantly improve; however, oesophageal acid exposure normalized in all patients.

Conclusions:

• LNF provides satisfactory symptomatic and objective reflux control after EsophyX failure.
• Prior EsophyX increases the risk of gastric injury during LNF.
• A notable rate of postfundoplication dysphagia is associated with LNF after EsophyX.