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Reoperation for disruption and recurrence after Nissen fundoplication
Archives of Surgery (Chicago, Ill. : 1960)
|April 1, 1979
Summary
This study reviews 25 failed Nissen operations, presenting a classification method and successful repair techniques. Intraoperative manometrics and posterior gastropexy improved outcomes in difficult cases, achieving good to excellent results in most patients.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Outcomes
Background:
- Nissen fundoplication is a common anti-reflux surgery.
- Failures can lead to significant patient morbidity.
- A systematic approach to failed cases is needed.
Purpose of the Study:
- To classify types of Nissen operation failures.
- To evaluate a novel surgical approach for failed Nissen operations.
- To document outcomes and complications.
Main Methods:
- Classification of 25 failed Nissen operations.
- Intraoperative manometric studies in select patients.
- Surgical repair utilizing posterior gastropexy.
- Literature review of Nissen fundoplication complications.
Main Results:
- A novel classification system for Nissen failure was developed.
- Disordered motor activity was identified in 10 patients.
- Successful antireflux repair with posterior gastropexy was achieved in difficult cases.
- 22 of 24 patients had good to excellent outcomes post-repair.
- Complications ranged from gas-bloat syndrome to fistulas.
Conclusions:
- A systematic classification and repair strategy can improve outcomes for failed Nissen operations.
- Intraoperative manometrics aids in creating effective antireflux barriers.
- Posterior gastropexy is a valuable technique for complex cases.
- Careful patient selection and surgical technique are crucial to minimize complications.