Conversion from failed antireflux surgery to RefluxStop: A multicenter feasibility, technical evaluation, safety, and...

This study evaluates the feasibility of RefluxStop conversion after failed antireflux surgery (ARS). Failed ARS necessitating re-surgery is common (comprising explantation, dysphagia, migration/erosion, hernia and reflux recurrence) and technicalities of original ARS may restrict subsequent options.

A two-center retrospective study of 30 consecutive subjects was conducted evaluating feasibility of RefluxStop conversion after failed ARS. Other clinical outcomes included safety, symptomatology, GERD Health-Related Quality-of-Life (GERD-HRQL), and proton pump inhibitor (PPI) use.

Thirty (N = 30) subjects underwent RefluxStop conversion from MSAࣧ-43.3%; fundoplicationࣧ-36.7%; EndoStimࣧ-10%; and Otherࣧ-10%. Revision with RefluxStop was straightforward in all cases. Baseline characteristics included: median age 55 years; 33.3% had large hiatal hernia (HH) ≥4 cm in size. At a mean follow-up of 22.3 months, median total score improved by 87.2% (pre- and post-GERD-HRQL available in n = 28/30). Symptoms improved from baseline to 1-year: general reflux symptoms (n = 26 vs. n = 3); regurgitation (n = 11 vs. n = 2); dysphagia (n = 10 vs. n = 2), respectively, and PPI use decreased from n = 28 at baseline to n = 3. Two reoperations for HH recurrence (preoperatively both 4 cm) due to total collapse of the hiatal repair, one second hernia recurrence post-MSA and one third hernia recurrence post-two Toupets, reoperated with hiatoplasty and plication extension, and hiatoplasty alone, respectively.

Conversion to RefluxStop surgery was feasible regardless of prior ARS. Conversion from both fundoplication and MSA were straightforward, although fundoplication required careful handling of vagus nerves, hiatal repair, and plication dissection; MSA being even simpler. At a mean follow-up of 22.3 months, median total GERD-HRQL score improved by 87.2%.