Long-term results after laparoscopic reoperation for failed antireflux procedures

Area of Science:

• Gastroenterology
• Surgical Innovation
• Patient Outcomes

Background:

• Redo anti-reflux surgery is more complex than primary fundoplication.
• Success rates for redo surgery are generally lower than for primary procedures.
• This study evaluates long-term results of laparoscopic surgery for failed fundoplication.

Purpose of the Study:

• To assess long-term subjective and objective outcomes after laparoscopic redo surgery for failed fundoplication.
• To identify common failure patterns and their impact on patient results.
• To investigate potential reasons for high failure rates in redo anti-reflux procedures.

Main Methods:

• Retrospective analysis of 129 patients undergoing laparoscopic redo surgery.
• Assessment of outcomes using radiological, endoscopic, symptom questionnaires, and quality-of-life indices.
• Minimum follow-up of 12 months (mean 75.8 months).

Main Results:

• Hiatal herniation (50 patients) and slippage (45 patients) were the most common failure patterns.
• Symptom resolution was achieved in 27/37 for recurrence and 11/16 for dysphagia.
• Objective failure occurred in 16/39 with herniation and 6/22 with slippage; 7 patients required further surgery.

Conclusions:

• Laparoscopic repair for failed fundoplication has a high long-term failure rate.
• Failure rates increase with longer follow-up periods.
• Untreated esophageal shortening is a potential cause for the observed high failure rate.