Laparoscopic revisional surgery for failed anti-reflux procedures.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Anti-reflux surgery, such as fundoplication, has a failure rate of 2-17% in adults.
• Revisional surgery is often necessary after failed primary anti-reflux procedures.
• These revisional surgeries are technically demanding and require specialized surgical expertise.

Purpose of the Study:

• To present the authors' experience with revisional surgical procedures for complications or recurrences after anti-reflux surgeries.
• To evaluate the range of techniques employed in revisional anti-reflux surgery.
• To assess the outcomes and challenges associated with revisional anti-reflux procedures.

Main Methods:

• Retrospective analysis of 18 patients who underwent revisional surgery for failed fundoplication between 2014 and 2019.
• Patients were referred from other centers, highlighting the complexity of cases.
• Surgical procedures included hiatal hernia repair with mesh, fundoplication reconstruction, mesh removal, and gastric wedge resection.

Main Results:

• The most common indication for revisional surgery was persistent reflux symptoms (61.2%), followed by recurrent hiatal hernia (10 patients).
• The mean operative time was 107.2 minutes, with a median hospital stay of 2.9 days.
• Morbidity occurred in 27.8% of patients, including gastric perforation and pleural opening; 11.1% of revisional surgeries failed, requiring re-revisional surgery.

Conclusions:

• Revisional surgery for failed anti-reflux procedures necessitates a diverse set of techniques, not limited to re-fundoplication.
• Procedures may include takedown of previous fundoplication, mesh removal, suture removal, or gastric wedge resection.
• Laparoscopic approaches, when performed by experienced surgeons in specialized centers, can achieve successful outcomes in revisional anti-reflux surgery.