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Reoperation following failed fundoplication.

J R Siewert, J Isolauri, H Feussner

    World Journal of Surgery
    |November 1, 1989
    PubMed
    Summary
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    Reoperation for failed Nissen fundoplication can achieve good results, with refundoplication recommended when anatomy is salvageable. Preoperative evaluation is crucial for successful outcomes in patients with recurrent gastroesophageal reflux disease.

    Area of Science:

    • Gastroenterology
    • Surgical Gastroenterology
    • Gastrointestinal Surgery

    Background:

    • Nissen fundoplication is a common surgical treatment for gastroesophageal reflux disease (GERD).
    • Failure of the initial Nissen fundoplication necessitates reoperation, presenting unique surgical challenges.

    Purpose of the Study:

    • To evaluate the outcomes of reoperation for failed Nissen fundoplication.
    • To identify the causes of Nissen fundoplication failure and assess the efficacy of revision surgery.

    Main Methods:

    • Retrospective analysis of 50 patients undergoing reoperation for failed Nissen fundoplication.
    • Patients were divided into two groups based on the timing of their initial surgery (before 1983 and 1983-1988).
    • Causes of failure and surgical techniques for reoperation (including refundoplication) were analyzed.

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    Main Results:

    • Common causes of failure included disrupted fundic wrap and slipped fundoplication.
    • Refundoplication was successful in 84% of cases where dissection was possible.
    • Excellent or good results were achieved in 66% of patients in the earlier group and 76% in the later group.
    • Operative mortality was 2% and morbidity was 4%.

    Conclusions:

    • Repeat fundoplication (refundoplication) is recommended when feasible, often via an abdominal approach.
    • Thorough preoperative assessment, including pH monitoring and manometry, is essential.
    • Satisfactory outcomes can be expected in a significant majority of patients undergoing reoperation for failed Nissen fundoplication.