Long-term results of redo gastro-esophageal reflux disease surgery.
OBJECTIVE
To review the long-term results of redo gastro-esophageal reflux disease (GERD) surgery with special emphasis on residual acid-suppressing medications, pH monitoring results, and quality of life.


METHODS
Retrospective analysis of 52 patients (24 males) who underwent redo GERD surgery between 1986 and 2006 through a transthoracic (n=14), or a transabdominal (n=38) approach. Indications were recurrent GERD in 41 patients, and complication of the initial surgery in 11. Quality of life was evaluated by telephone enquiry using a validated French questionnaire (reflux quality score, RQS).


RESULTS
Postoperative complications occurred in 18 patients (35%), resulting in one death (2%). Reoperation was required in seven patients. At 1 year, 26 patients (51%) had 24h pH monitoring, among whom 2 (8%) were proved to have recurrence of GERD. RQS values were calculated in 38 patients with a mean follow-up of 113 months. Fifty percent of this subgroup had a RQS value beyond 26/32, indicating an excellent quality of life. Among these 38 patients, 20 (53%) had acid-suppressing medications whatever their RQS values. Patients who underwent transthoracic GERD surgery had the highest RQS values (p=0.02), a lower rate of complications (p=0.06) and a lower rate of reoperation (p=0.04).


CONCLUSIONS
Our experience confirms that selection of candidates for redo GERD surgery is a challenging issue. A transthoracic approach seems to produce better results and lower rates of complications.
Avaro
Jean-Philippe
JP
University of the Mediterranean, Faculty of Medicine, Department of Thoracic surgery and Diseases of the Oesophagus, Sainte Marguerite University Hospital, Marseille, France.
D'Journo
Xavier-Benoît
XB
Trousse
Delphine
D
Ouattara
Moussa A
MA
Doddoli
Christophe
C
Giudicelli
Roger
R
Fuentes
Pierre A
PA
Thomas
Pascal A
PA
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006305:Health Status Indicators; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D018579:Patient Selection; D011183:Postoperative Complications; D011594:Psychometrics; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome