title: Failed antireflux surgery: quality of life and surgical outcome after laparoscopic refundoplication.
abstract: OBJECTIVE
  Laparoscopic antireflux surgery has in recent years become the standard procedure for treating severe gastroesophageal reflux disease. Both laparoscopic antireflux surgery and open surgery cause failures which lead to repeat surgery in 3-6% of cases. We evaluated prospectively quality of life and surgical outcome following laparoscopic refundoplication for failed initial antireflux surgery.
  
  
  METHODS
  We prospectively studied 51 patients undergoing laparoscopic refundoplication for primary failed antireflux surgery, with complete follow-up 1 year after surgery. In 20 cases the initial surgery used the open technique; four had surgery twice previously. In 31 cases primary procedure was performed laparoscopically. Indication for repeat surgery were recurrent reflux ( n=29), dysphagia ( n=12), and a combination of the two ( n=10). Preoperative and postoperative data including 24-h pH monitoring, esophageal manometry, and quality of life (Gastrointestinal Quality of Life Index) were used to assess outcome.
  
  
  RESULTS
  Forty-nine procedures (96%) were completed by the laparoscopic technique. Conversion was necessary in two cases with primary open procedure, in one patient because of injury to the gastric wall and in one severe bleeding of the spleen. Postoperatively two patients (3.9%) suffered from dysphagia and required pneumatic dilatation within the first postoperative year. Average operating time was 245 min after an initial open procedure and 80 min after an initial laparoscopic procedure. The lower esophageal sphincter pressure increased significantly from preoperatively 2.8+/-1.8 mmHg at 3 months (12.8+/-4.1 mmHg) and 1 year (12.3+/-3.9 mmHg) after repeat surgery. In these cases the DeMeester score decreased significantly from preoperative 67.9+/-10.3 to 15.5+/-9.4 at 3 months and 13.1+/-8.1 at 1 year after surgery. Mean Gastrointestinal Quality of Life Index increased from 86.7 points preoperatively to 121.6 points at 3 months and 123.8 points at 1 year and was comparable to that of a healthy population (122.6 points).
  
  
  CONCLUSIONS
  Laparoscopic repeat surgery for recurrent or persistent symptoms of gastroesophageal reflux disease is effective and can be performed safely with excellent postoperative results and a significant improvement in patient's quality of life for a follow-up period of 1 year.
authors.affiliation: Department of General Surgery, Hospital Zell am See, Paracelsusstrasse 8, 5700 Zell am See, Austria. FAGZELLAMSEE@yahoo.com
authors.forename: Frank Alexander
authors.initials: FA
authors.lastname: Granderath
authors.forename: Thomas
authors.initials: T
authors.lastname: Kamolz
authors.forename: Ursula Maria
authors.initials: UM
authors.lastname: Schweiger
authors.forename: Rudolph
authors.initials: R
authors.lastname: Pointner
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D011795:Surveys and Questionnaires; D017211:Treatment Failure