[Reoperation by thoracic approach after surgery for gastroesophageal reflux]

Eleven patients underwent left transthoracic reoperation for recurrence of hiatus hernia after previous surgical treatment. A left thoracic approach was chosen because of three cases of major obesity, three patients with multiple previous laparotomies, three recurrences of para-esophageal hernia, three associated dyskinetic disorders of lower esophagus. Ten patients underwent a Belsey Mark IV procedure with three myotomies of lower esophagus and one pyloroplasty. One patient underwent a Collis-Belsey procedure. Operative mortality was zero. Every patient had been followed up with a mean of 31 months. Ten patients have a good result. One patient had a massive recurrence of gastroesophageal reflux after Belsey Mark IV which led to a duodenal diversion 18 months later. Although the abdominal approach allows easier dissection of lower esophagus and complementary procedures to the lower esophagus. Results are as good as those of the abdominal approach.