Reoperative laparoscopic antireflux surgery.
BACKGROUND
Laparoscopic antireflux surgery (LAP) is becoming increasingly used for the surgical treatment of medical recalcitrant gastroesophageal reflux disease (GERD). We sought to determine the utility of remedial LAP approaches to antireflux surgery.


METHODS
From March 1996 to December 1998, 15 patients underwent remedial LAP to manage medically recalcitrant recurrent GERD after LAP (n = 8) or open antireflux procedure (n = 1) and/or troublesome postfundoplication complications (dysphagia 6, gas bloat 4). The remedial LAP surgery consisted of conversion from Nissen to Toupet fundoplication to manage dysphagia or gas bloat symptoms (n = 7), revision of IAP Nissen fundoplication (n = 7) and LAP revision of a failed open Nissen fundoplication (n = 1) for recurrent reflux.


RESULTS
The remedial LAP repair was accomplished in all patients. Findings at operation included disrupted fundoplication (n = 6), incomplete or inappropriately positioned fundoplication (n = 2), paraesophageal hernia (n = 3), or a normal total fundoplication among patients with primary dysphagia (n = 4). Follow-up symptom scoring beyond 3 months of remedial surgery demonstrated a change from the preoperative mean dysphagia, heartburn, gas bloat, and regurgitation score (P < .05). Follow-up GERD testing (manometry, upper gastrointestinal tract, pH testing) was normal in 13 of the 15 patients.


CONCLUSIONS
Reoperative antireflux surgery can be accomplished using LAP approaches without compromise of therapeutic intent or increased surgical morbidity. Surgeons sufficiently experienced with these LAP repairs may consider repeat LAP instead of open surgery for patients with recurrent GERD or postfundoplication problems.
Szwerc
M F
MF
Division of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Wiechmann
R J
RJ
Maley
R H
RH
Santucci
T S
TS
Macherey
R S
RS
Landreneau
R J
RJ
D000328:Adult; D001464:Barium; D003680:Deglutition Disorders / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006356:Heartburn / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010147:Pain Measurement; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation
D001464:Barium