Laparoscopic reoperative antireflux surgery.
BACKGROUND
Antireflux operations for gastroesophageal reflux disease whether performed open or laparoscopically can fail and may require reoperation to control new, recurrent symptoms or operation-related complications. We report our experience with the laparoscopic reoperation for failed antireflux procedures.


METHODS
Between 1995 and 2000, 37 patients underwent laparoscopic reoperative antireflux procedures. The mean age and weight were 52 years and 181.5 pounds. The main presenting symptoms were heartburn (n = 18), respiratory reflux (n = 4), chest pain (n = 3), regurgitation (n = 1), and dysphagia (n = 10). The mean duration between the first operation and recurrence of symptoms was 18 months, and the duration between the two procedures was 25 months. The operation was completed laparoscopically in 32 patients (86.5%): Nissen fundoplication (n = 27) and Toupet fundoplication (n = 9).


RESULTS
Intraoperative and postoperative complications occurred in 6 and 14 patients, respectively. Fundoplication disruption was the most common cause of primary surgery failure. The mean hospital stay was 4 days. At a mean follow-up of 26.5 months, results were excellent to good (65%), fair (21.5%), and poor (13.5%).


CONCLUSIONS
Laparoscopic reoperative antireflux procedures are technically feasible with acceptable preliminary results.
Awad
Z T
ZT
Department of Surgery, Suite 3740, Creighton University School of Medicine, 601 N. 30th Street, Omaha, NE 68131, USA.
Anderson
P I
PI
Sato
K
K
Roth
T A
TA
Gerhardt
J
J
Filipi
C J
CJ
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery*; D006356:Heartburn / Q000209:etiology / Q000601:surgery; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods*