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Re-operation for failed anti-reflux surgery

J K Lim1, E Moisidis, W S Munro

  • 1Department of Surgery, Concord, Strathfield Adventist Hospital, New South Wales, Australia.

The Australian and New Zealand Journal of Surgery
|November 1, 1996
PubMed
Summary
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Re-operative anti-reflux surgery, primarily transabdominal Nissen fundoplication, shows good outcomes. This approach offers acceptable complication rates and excellent symptom relief for patients with failed previous anti-reflux procedures.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Patient Outcomes

Background:

  • 315 anti-reflux procedures performed between 1993-1995.
  • 10% of patients (31) had prior anti-reflux surgery, predominantly Nissen fundoplication (80%).

Purpose of the Study:

  • To evaluate the outcomes of re-operative anti-reflux surgery.
  • To identify causes of failure in previous anti-reflux procedures.

Main Methods:

  • Pre-operative diagnostics included manometry, 24h pH monitoring, oesophagoscopy, and barium radiology.
  • Transabdominal approach used in 94% of re-operations.
  • Complication rate was 16%.

Main Results:

  • Causes of failure identified: hiatal (65%), oesophageal dysmotility (10%), and fundoplication (25%).

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  • 91% of patients reported good to excellent symptomatic outcomes at a mean 21-month follow-up.

    • Conclusions:

    • Transabdominal re-operative anti-reflux surgery is effective.
    • The procedure demonstrates an acceptable complication rate and favorable medium-term symptomatic results.