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Laparoscopic repair for failed antireflux procedures.

George Makdisi1, Francis C Nichols1, Stephen D Cassivi1

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Laparoscopic reoperation for failed antireflux surgery is safe and effective for most patients, offering significant symptom improvement. However, long-term functional results may decline over time.

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Area of Science:

  • Gastroenterology
  • Minimally Invasive Surgery
  • Surgical Outcomes

Background:

  • Minimally invasive procedures are increasingly common.
  • Laparoscopic reoperations for failed antireflux procedures are rising.
  • Outcomes of these reoperations require further study.

Purpose of the Study:

  • To evaluate the outcomes of laparoscopic reoperations for failed antireflux procedures.
  • To assess safety and efficacy in a selected patient cohort.

Main Methods:

  • Retrospective review of medical records for patients undergoing reoperation without esophageal resection.
  • Data collected between January 2000 and October 2012.
  • Analysis of intraoperative findings, procedures performed, complications, and patient outcomes.

Main Results:

  • 75 patients (56 women, 19 men; median age 58) underwent reoperation.
  • Recurrent hiatal hernia (63%) and incompetent fundoplication (19%) were common findings.
  • Symptom improvement was observed in 93% early and 78% long-term.
  • Excellent or good functional results were achieved in 85% of patients.

Conclusions:

  • Laparoscopic reoperation for failed antireflux surgery is complex but safe and effective in selected patients.
  • A majority achieve good to excellent functional status post-reoperation.
  • Long-term outcomes may show deterioration, necessitating careful patient selection and follow-up.