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Reoperation after failed antireflex surgery. Review of 101 cases
F H Ellis1, S P Gibb, G J Heatley
1Division of Cardiothoracic Surgery, Deaconess Hospital and Harvard Medical School, Boston, MA 02115, USA.
Summary
Reoperation for failed antireflux surgery, often due to faulty technique, improved 80% of patients. A more radical approach is recommended after two failed reoperations for persistent acid reflux.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Reflux Management
Background:
- Antireflux procedures, commonly Nissen fundoplication, can fail.
- Reoperation is necessary for persistent symptoms after initial anti-reflux surgery.
- Identifying reasons for failure is crucial for successful reintervention.
Purpose of the Study:
- To evaluate outcomes of reoperation for failed antireflux procedures.
- To identify common causes of antireflux surgery failure.
- To determine optimal surgical strategies for reoperation.
Main Methods:
- Retrospective review of 101 patients undergoing reoperation for failed antireflux surgery between 1970 and 1994.
- Analysis of previous operations, reasons for failure, and reoperation techniques.
- Assessment of patient outcomes following reoperation.
Main Results:
- 80% of patients improved after reoperation.
- Faulty surgical technique was the primary cause of initial failure (65%).
- Incorrect diagnosis contributed to remaining failures (22%).
Conclusions:
- Reoperation can significantly improve outcomes in patients with failed antireflux surgery.
- Takedown or refashioning of the original wrap is often effective.
- A more radical approach, including vagotomy, antrectomy, and Roux-en-Y diversion, is considered for recurrent failures.