Laparoscopic re-operation from gastro-oesophageal reflux

Area of Science:

• Gastroenterology and Hepatology
• Minimally Invasive Surgery

Background:

• Laparoscopic surgery for gastro-oesophageal reflux disease (GERD) is common, but failures can necessitate re-operation.
• Re-operations for GERD are complex and require careful patient selection and surgical technique.

Purpose of the Study:

• To evaluate the efficacy and outcomes of laparoscopic re-operations for failed GERD surgery.
• To identify causes of failure and assess the advantages of laparoscopy in re-operative GERD management.

Main Methods:

• Retrospective review of five patients who underwent laparoscopic re-operation for failed GERD surgery between 1994 and present.
• Surgical procedures included Nissen-Rossetti fundoplication, Rossetti-Hell operation, duodenal diversion, hiatoplasty, and conversion to Toupet fundoplication.
• Pre-operative assessment included morphological and functional esophageal evaluation; post-operative assessment evaluated clinical results.

Main Results:

• Five patients with failed laparoscopic GERD surgery underwent re-operation.
• Causes of failure included recurrent GERD with short esophagus, recurrent hiatal hernia, and post-operative dysphagia due to anti-reflux valve issues or inappropriate fundoplication.
• All five patients had excellent post-operative courses and clinical results following laparoscopic re-operation, including conversion to duodenal diversion, hiatoplasty, or Toupet fundoplication.

Conclusions:

• Laparoscopic re-operation is effective for managing failures of initial GERD surgery.
• Accurate pre-operative assessment is crucial for selecting the appropriate re-operative strategy.
• Laparoscopy offers excellent visualization and is advantageous for correcting complex GERD failures.