[Redo surgery after laparoscopic fundoplication]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Laparoscopic fundoplication is a common anti-reflux surgery.
• Recurrent symptoms or complications may necessitate redo surgery.
• Understanding outcomes of repeat anti-reflux procedures is crucial.

Purpose of the Study:

• To analyze the outcomes of redo surgeries following initial laparoscopic fundoplication.
• To identify causes of unsatisfactory results after primary anti-reflux surgery.
• To compare redo surgery outcomes with primary anti-reflux surgery.

Main Methods:

• Retrospective analysis of 37 redo anti-reflux surgeries.
• Comparison with a control group of 38 patients undergoing primary anti-reflux surgery.
• Evaluation of causes for initial surgery failure, intraoperative data, and short/long-term results.
• Quality of life assessment using the GIQLI questionnaire.

Main Results:

• Recurrent reflux often resulted from hernia recurrence and fundoplication cuff issues.
• Dysphagia was commonly linked to esophageal compression from diaphragmatic crura or recurrent hernia.
• Redo surgeries involved longer operating times, hospital stays, and higher complication rates.
• Significant quality of life improvement was noted in the redo surgery group, attributed to lower baseline scores.

Conclusions:

• Redo anti-reflux surgeries are effective and safe, offering significant long-term quality of life improvements.
• Technical difficulties in redo procedures are acknowledged.
• Persistent dysphagia is often related to diaphragm repair, while reflux recurrence is linked to cuff slippage and hernia recurrence.