Symptoms and reflux competence in relation to anatomical findings at reoperation after laparoscopic total fundoplication.
OBJECTIVE
To investigate the mechanisms and anatomical failures after total laparoscopic fundoplication using the symptoms and findings at reoperation.


METHODS
Prospective open study.


METHODS
University hospital, Sweden.


METHODS
Twenty-one patients who were reoperated on a median of 33 (0.5-102) months after laparoscopic fundoplication.


METHODS
The patients were divided into three groups according to the mode of presentation. The first group presented with dysphagia and no gastro-oesophageal reflux (GOR) (n = 6). The second group (n = 11) had recurrent GOR and the third group (n = 4) complained of a sense of excessive fullness.


RESULTS
In the dysphagia group the reason for it in 4 patients was severe fibrosis in the hiatal region including the right part of the fundoplication. One patient had correctly located fundoplication but it was too tight. In the last patient the part of the stomach used was too low down. All patients in the GOR group had a slippage and rupture of the fundoplication. Ten patients also had a recurrent hernia. In 6/11 patients the fundal mobilisation was incomplete. In the last group (excessive fullness) one patient had a postoperative leak from the fundal part, one patient a para-oesophageal hernia, and one patient an intact but herniated repair. One further patient had an intact abdominal oesophagus and crural repair, but a large portion of the stomach had herniated through the left part of the fundoplication and acted as a volvulus.


CONCLUSIONS
Dysphagia was caused by hiatal fibrosis or other technical failures rather than a normal tight fundoplication. Using the wrong part of the stomach causes recurrent heartburn. The laparoscopic suturing technique must be improved.
Franzén
Thomas
T
Department of Surgery, University Hospital, Linköping, Sweden. thomas.franzen@lio.se
Johansson
Karl-Erik
KE
D000328:Adult; D017677:Age Distribution; D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006356:Heartburn / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology