Laparoscopic management of failed antireflux surgery

Whether performed open or laparoscopically, antireflux procedures for gastroesophageal reflux disease sometimes fail and may require reoperation for optimal results. Between June 1992 and May 1995 eight patients presented with a failed antireflux procedure. Four patients had previously had a Belsey operation performed through the chest, two had had open Nissen fundoplications, and two had Nissen fundoplications performed via laparoscopy. Preoperative workup included cardiac, hematologic, and pulmonary evaluation as well as Esophagogastroduodenscopy (EGD), esophageal manometry, and 24-h pH studies to document reflux as a cause of recurrent symptoms. Two patients had aspiration symptoms even on medication. All patients had severe esophagitis on biopsy. Six reoperations (75%) were completed laparoscopically. In two patients we converted to open procedures due to an inability to expose the esophageal hiatus secondary to adhesions between the left lobe of the liver and the stomach. Of the six patients completed laparoscopically, one had a Nissen fundoplication and the others had a 200 degrees partial wrap. Two patients developed left pneumothorax, one patient required a single postoperative dilation, and one patient treated with open surgery developed pneumonia. The average hospitalization for laparoscopy was 2.2 days (range, 1-4 days), while those two who underwent open surgery stayed in the hospital 5 and 6 days. All patients were followed from 12 to 42 months and all are currently off medication and free of symptoms. Laparoscopic re-exploration for esophageal reflux disease can be safely performed with excellent results.