title: Long-term results after laparoscopic reoperation for failed antireflux procedures.
abstract: BACKGROUND
  Surgery for failed antireflux procedures is technically more demanding than primary fundoplication. The success rate does not equal that of the primary procedures. This retrospective analysis aimed to assess long-term subjective and objective outcomes in patients who underwent laparoscopic surgery for fundoplication failure.
  
  
  METHODS
  Objective and subjective outcomes were assessed by radiological and endoscopic methods, symptom questionnaire and quality-of-life index at a minimum follow-up of 12 (mean 75·8) months.
  
  
  RESULTS
  The study included 129 consecutive patients who had laparoscopic redo surgery after fundoplication had failed. The most frequent patterns of failure were hiatal herniation (50 patients) and slippage (45). Resolution of the symptoms that led to redo surgery was achieved in 27 of 37 and 11 of 16 patients operated for recurrence and for dysphagia respectively. Objective failure was demonstrated in 16 of 39 patients with herniation and six of 22 with slippage. Seven patients underwent an additional surgical procedure.
  
  
  CONCLUSIONS
  Long-term assessment of objective and subjective results after laparoscopic repair for failed fundoplication revealed a high failure rate that increased with the length of follow-up. Unexpected and untreated oesophageal shortening may be responsible for this failure rate.
authors.affiliation: Department of Digestive and Endocrine Surgery and Institut de Recherche Contre les Cancers de l'Appareil Digestif, University Hospital of Strasbourg, Strasbourg, France. bernard.dallemagne@ircad.fr
authors.forename: B
authors.initials: B
authors.lastname: Dallemagne
authors.forename: M
authors.initials: M
authors.lastname: Arenas Sanchez
authors.forename: D
authors.initials: D
authors.lastname: Francart
authors.forename: S
authors.initials: S
authors.lastname: Perretta
authors.forename: J
authors.initials: J
authors.lastname: Weerts
authors.forename: S
authors.initials: S
authors.lastname: Markiewicz
authors.forename: C
authors.initials: C
authors.lastname: Jehaes
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006356:Heartburn / Q000209:etiology; D006547:Hernia / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D017211:Treatment Failure