title: Long-term outcomes of revisional surgery following laparoscopic fundoplication.
abstract: BACKGROUND
  A small proportion of patients who have laparoscopic antireflux procedures require revisional surgery. This study investigated long-term clinical outcomes.
  
  
  METHODS
  Patients requiring late revisional surgery following laparoscopic fundoplication for gastro-oesophageal reflux were identified from a prospective database. Long-term outcomes were determined using a questionnaire evaluating symptom scores for heartburn, dysphagia and satisfaction.
  
  
  RESULTS
  The database search found 109 patients, including 98 (5.6 per cent) of 1751 patients who had primary surgery in the authors' unit. Indications for surgical revision were dysphagia (52 patients), recurrent reflux (36), mechanical symptoms related to paraoesophageal herniation (16) and atypical symptoms (five). The median time to revision was 26 months. Outcome data were available for 104 patients (median follow-up 66 months) and satisfaction data for 102, 88 of whom were highly satisfied (62.7 per cent) or satisfied (23.5 per cent) with the outcome. Patients who had revision for dysphagia had a higher incidence of poorly controlled heartburn (20 versus 2 per cent; P = 0.004), troublesome dysphagia (16 versus 6 per cent; P = 0.118) and a lower satisfaction score (P = 0.023) than those with recurrent reflux or paraoesophageal herniation.
  
  
  CONCLUSIONS
  Revisional surgery following laparoscopic fundoplication can produce good long-term results, but revision for dysphagia has less satisfactory outcomes.
authors.affiliation: University of Adelaide Discipline of Surgery, Royal Adelaide Hospital, South Australia, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Lamb
authors.forename: J C
authors.initials: JC
authors.lastname: Myers
authors.forename: G G
authors.initials: GG
authors.lastname: Jamieson
authors.forename: S K
authors.initials: SK
authors.lastname: Thompson
authors.forename: P G
authors.initials: PG
authors.lastname: Devitt
authors.forename: D I
authors.initials: DI
authors.lastname: Watson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006356:Heartburn / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult