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Reoperation for failed reflux surgery.

Marcello Migliore1

  • 1Section of Thoracic Surgery, Department of Surgery, University of Catania, Catania, Italy.

Multimedia Manual of Cardiothoracic Surgery : MMCTS
|January 14, 2014
PubMed
Summary
This summary is machine-generated.

Gastroesophageal reflux surgery can fail due to technical issues like tight closures or wrap problems. Laparoscopic surgery is standard for reoperations, while transthoracic approaches suit complex cases.

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Area of Science:

  • Gastroenterology and Surgical Procedures
  • Anti-reflux Surgery Outcomes

Background:

  • Gastroesophageal reflux disease (GERD) surgery aims to restore the anti-reflux barrier.
  • Surgical failure can result from various technical complications, including hiatal hernia recurrence and wrap integrity issues.

Purpose of the Study:

  • To outline common failure modes in anti-reflux surgery.
  • To discuss the current standards of care for managing surgical failure and complications.

Main Methods:

  • Review of common causes of failure in gastroesophageal reflux surgery.
  • Evaluation of surgical approaches for reoperation after initial anti-reflux procedures.

Main Results:

  • Common failures include overly tight crural closure, fundoplication tightness, recurrent hiatal hernia, wrap disruption, and wrap slippage.
  • Laparoscopic reoperation is the standard for managing failures after initial laparoscopic anti-reflux surgery.
  • Transthoracic approaches are valuable for patients requiring multiple reoperations or facing complex complications.

Conclusions:

  • Understanding failure mechanisms is crucial for successful revision surgery.
  • The choice of surgical approach for revision depends on the complexity and number of prior operations.