Reoperation for failed antireflux surgery

The management of patients with an unsatisfactory result following antireflux surgery is often problematical. Ten such patients with failed antireflux surgery, for whom medical management had also subsequently failed, underwent reoperation via a thoraco-abdominal approach. The anatomical cause of the surgical failure was determined pre-operatively in most cases by endoscopy, radiology, manometry and 24-hour pH monitoring. The most common reason for failure was a slipped Nissen fundoplication. A tight wrap, a disrupted wrap and a fundoplication hernia were less common causes. At follow-up, only one patient had a poor result. Reoperation for failed antireflux surgery can yield good results and is facilitated by pre-operative definition of the cause of failure and wide operative exposure.