Early reoperation after laparoscopic fundoplication: the importance of routine postoperative contrast studies.
BACKGROUND
The necessity for routine postoperative contrast studies following laparoscopic fundoplication for either gastroesophageal reflux disease or paraesophageal hernia is unclear.


METHODS
To determine whether a routine contrast X-ray film influenced surgical decision making following laparoscopic fundoplication, we reviewed records from a prospective database of 1,894 patients who underwent a primary laparoscopic fundoplication for gastroesophageal reflux disease or paraesophageal hernia between October 1991 and June 2008, and identified those who underwent early reoperation. The value of early routine postoperative barium swallow examinations in the management of these patients was then determined.


RESULTS
The review showed that 53 patients (2.8%) underwent reoperative procedures within seven days of their original operation: 21 had originally undergone surgery for a paraesophageal hernia, and 32 for reflux. Of the 53 patients who underwent reoperation, 25 (47.2%) were treated for dysphagia, 17 (32.1%) for acute paraesophageal hernia, 6 (11.3%) for a gastrointestinal leak, and 5 (9.4%) for bleeding or peritonitis. Fifteen of the 17 patients who underwent repair of an acute hiatus hernia (0.8% of all patients) had no symptoms and underwent reoperative surgery because of radiological findings alone. Primary surgery for a large hiatus hernia was associated with a higher incidence of early reoperation (5.2 vs. 2.2%; P = 0.001).


CONCLUSIONS
Approximately 1 in 125 patients who underwent laparoscopic surgery for reflux or a large hiatus hernia had an important finding on an early postoperative contrast swallow, and benefited from this investigation by undergoing early reoperative intervention.
Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA 5000, Australia.
Shigeru
S
Tsunoda
Glyn G
GG
Jamieson
Peter G
PG
Devitt
David I
DI
Watson
Sarah K
SK
Thompson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D016009:Chi-Square Distribution; D003287:Contrast Media; D003657:Decision Making; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging* / Q000601:surgery*; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome
D003287:Contrast Media; D001466:Barium Sulfate