Surgical management after failed antireflux operations.
From 1973 to 1989, 117 (28%) patients underwent re-operation for failed antireflux surgery from a total of 413 esophagogastric operations for gastro-esophageal reflux disease. Seventy-eight patients who underwent re-operation before 1984 were reviewed in detail for classification and long-term outcome. Forty re-operations followed a failed Nissen fundoplication, while no other procedure was the most recent prior operation in more than 10 patients. Re-operation rates were 3% following prior surgery in our clinic for reflux disease other than stricture and 9.6% if the prior operation was done for stricture. There was no difference in re-operation rates for the Belsey Mark IV or Nissen fundoplication, the 2 most commonly used repairs. In each case, complete pre-operative evaluations included symptom score, radiography, endoscopy, and esophageal function tests. Based on the results, the 78 patients were classified as pure sphincter mechanism failure to stop reflux (n = 14), pure esophageal clearance failure (n = 12), combined sphincter mechanism failure and clearance failure (n = 29), alkaline reflux (n = 9), or no reflux but another condition found (n = 14). Patients having symptoms following a prior Nissen fundoplication or Angelchik prosthesis insertion were more likely to have esophageal clearance failure than those having other repairs. The classification proved to be a useful guide to the need for and types of re-operation chosen. Among the 117 patients undergoing re-operation, there were 2 (1.7%) deaths within 3 months of surgery and 25 (21%) complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Skinner
D B
DB
New York Hospital, Cornell Medical Center, New York 10021.
D004940:Esophageal Stenosis / Q000145:classification / Q000503:physiopathology / Q000601:surgery; D004942:Esophagitis, Peptic / Q000601:surgery; D004943:Esophagogastric Junction / Q000503:physiopathology / Q000601:surgery; D005748:Gastric Fundus / Q000503:physiopathology / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000145:classification / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome