Perioperative outcomes of surgical procedures for symptomatic fundoplication failure: a retrospective case-control...

Anatomic failure with recurrent gastroesophageal reflux disease (GERD) or related symptoms following fundoplication is a well-described occurrence. Occasionally, reoperative surgery is required. The morbidity of revisional surgery can be quite high, and the clinical outcomes may not be as good as is observed following primary antireflux operations.

Data were obtained from a prospectively maintained foregut surgery database and via follow-up survey. Patients who underwent surgery for symptomatic failed fundoplication were included. A control group consisting of the same number of patients who underwent a first-time fundoplication for GERD was randomly selected from the same database. Anatomic failure of the original fundoplication was confirmed in all cases with upper endoscopy and an upper-GI series. Perioperative outcomes were compared between study groups. Visick scores were attained via phone follow-up along with satisfaction scores related to the outcome.

From January 2003 to January 2010, 38 patients underwent revisional operations for failed fundoplication at our institution. The majority of patients (74%) had one previous failed attempt at fundoplication (range = 1-3). The most common mechanism of failure was hiatal hernia with recurrent GERD (79%). Reoperative patients were similar to their controls (age, sex, and body mass index). Reoperative surgery took longer, patients remained in the hospital longer, and these patients experienced more complications. Despite this fact, satisfaction with the outcomes of surgery was high in each group. The majority of patients in each study group reported Visick scores of grade 1 (no symptoms, resolved) or grade 2 (mild occasional symptoms, easily controlled) after surgery.

Compared to primary antireflux surgery, revisional operations are associated with longer mean operating times, increased length of hospital stay, and increased morbidity. Despite this fact, the majority of patients are satisfied with the outcomes of revisional surgery for failed fundoplication, and symptomatic outcomes are good.