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Reoperations after failed antireflux procedures

J R Siewert1, H J Stein, H Feussner

  • 1Department of Surgery, Technische Universität München, Germany.

Annales Chirurgiae Et Gynaecologiae
|January 1, 1995
PubMed
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Failed anti-reflux procedures can cause persistent symptoms like dysphagia. Management requires individualized approaches beyond simple redo fundoplication, considering various causes and surgical options.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Laparoscopic Surgery

Background:

  • Laparoscopic anti-reflux procedures have surged in popularity, leading to an anticipated increase in post-operative complications.
  • Persistent, recurrent, or new symptoms after these procedures are becoming a more recognized clinical challenge.

Purpose of the Study:

  • To outline the complex etiologies of failed anti-reflux procedures.
  • To emphasize the need for tailored management strategies for patients experiencing post-fundoplication symptoms.
  • To highlight the surgeon's role in understanding a broad range of revisional and reconstructive techniques.

Main Methods:

  • Review of common causes for persistent symptoms after anti-reflux surgery.
  • Analysis of factors contributing to postoperative dysphagia and reflux.

Related Experiment Videos

  • Discussion of diagnostic considerations including functional tests and intraoperative findings.

    • Main Results:

    • Recurrent reflux often stems from repair breakdown, manageable with medication or repeat procedures.
    • Postoperative dysphagia can result from various technical issues (e.g., slipped, malpositioned, or tight wrap) or esophageal motility disorders.
    • Simple redo fundoplication is often insufficient for complex post-operative issues.

    Conclusions:

    • Management of failed anti-reflux procedures necessitates an individualized therapeutic strategy.
    • Successful outcomes depend on accurate diagnosis based on symptoms, functional testing, and surgical findings.
    • Surgeons must be proficient in a wide array of revisional, resective, and reconstructive surgeries for the stomach, cardia, and esophagus.