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Reoperation after failed antireflux surgery

N A Rieger1, G G Jamieson, R Britten-Jones

  • 1Department of Surgery, Royal Adelaide Hospital, South Australia.

The British Journal of Surgery
|August 1, 1994
PubMed
Summary
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Repeat antireflux surgery can be successful for patients with recurrent issues. However, surgeons should avoid pyloroplasty and gastric resection to improve outcomes and minimize complications.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Patient Outcomes

Background:

  • Antireflux surgery aims to correct gastroesophageal reflux disease.
  • Recurrent symptoms or complications may necessitate reoperation.
  • Understanding causes of failure is crucial for surgical planning.

Purpose of the Study:

  • To analyze the indications, causes, and outcomes of reoperation after initial antireflux surgery.
  • To evaluate the effectiveness of various reoperative techniques.
  • To identify factors influencing success and complications in repeat antireflux procedures.

Main Methods:

  • Retrospective review of 61 patients undergoing reoperation for antireflux surgery complications between 1978 and 1992.
  • Categorization of indications for reoperation (recurrent reflux, dysphagia, postprandial pain).

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  • Documentation of intraoperative findings, surgical procedures performed, and postoperative outcomes.

    • Main Results:

    • Recurrent reflux was the most common indication for reoperation (50 patients).
    • Anatomical breakdown, slipped Nissen procedures, and paraesophageal hernias were common causes of failure.
    • 51 out of 59 surviving patients reported successful outcomes, but pyloroplasty and gastric resection were associated with dumping symptoms.

    Conclusions:

    • Repeat antireflux procedures can achieve outcomes comparable to primary surgeries.
    • Careful surgical technique is essential, avoiding pyloroplasty and gastric resection where possible.
    • Identifying the cause of initial failure guides successful reoperation strategies.