Long-term results after reoperation for failed antireflux procedures

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Reflux Management

Background:

• Recurrent gastroesophageal reflux disease (GERD) after initial antireflux surgery presents a management challenge.
• Reoperation for failed antireflux procedures requires careful consideration of surgical approach and technique.
• Esophageal preservation is a key consideration in managing complex GERD cases.

Purpose of the Study:

• To evaluate the outcomes of reoperation for recurrent GERD in patients who did not undergo esophageal resection.
• To assess the safety, efficacy, and functional results of various surgical techniques in GERD reoperation.
• To determine if specific surgical approaches or procedures offer superior functional outcomes in reoperation for GERD.

Main Methods:

• Retrospective analysis of 185 patients undergoing reoperation for recurrent GERD between January 1960 and June 1995.
• Surgical approaches included thoracotomy, laparotomy, and thoracoabdominal incision.
• Procedures encompassed Nissen fundoplication, Belsey fundoplication, vagotomy and antrectomy with Roux-en-Y, anatomic hernia repair, and Hill gastropexy, with additions like Collis gastroplasty and pyloroplasty.

Main Results:

• A single operative death (0.5%) and a 25.4% complication rate were observed.
• Significant functional improvement was reported in 87.8% of patients.
• Functional results were excellent or good in 60.2% of patients, with no single procedure demonstrating superiority.

Conclusions:

• Reoperation for recurrent GERD with esophageal preservation is associated with significant functional benefits.
• The procedure can be performed with low mortality and acceptable morbidity.
• Tailoring the surgical repair to the individual patient is crucial for optimal outcomes.