title: Reoperative antireflux surgery for failed fundoplication: an analysis of outcomes in 275 patients.
abstract: BACKGROUND
  With an increase in the performance of laparoscopic antireflux procedures, more patients with a failed primary antireflux operation are being referred to thoracic surgeons for complex redo procedures. The objective of this study was to evaluate our results of redo antireflux surgery.
  
  
  METHODS
  We conducted a retrospective review of patients who underwent redo surgery for failed fundoplication. The primary endpoint was failure of the redo operation; other endpoints included gastroesophageal reflux disease-health-related quality of life (HRQOL) after redo fundoplication.
  
  
  RESULTS
  A total of 275 patients (median age, 52 years; range, 17 to 88 years; men 82, women 193) underwent redo antireflux surgery. The most common pattern of failure of the initial operation was transmediastinal migration-recurrent hernia in 177 patients (64%). Redo surgery included Nissen fundoplication in 200 (73%), Collis gastroplasty in 119 (43%), and partial fundoplication in 41 (15%). There was no perioperative mortality. At a median follow-up of 39.6 months, 31 patients (11.2%) had a failure of the redo surgery, requiring reoperation. The two-year estimated probability of freedom from failure was 93% (95% confidence interval 89% to 96%). The HRQOL scores, available for 186 patients, were excellent to satisfactory in 85.5%, and poor in 14.5%.
  
  
  CONCLUSIONS
  Redo antireflux surgery can be performed safely in experienced centers with outcomes that are similar to published open results. Complete takedown and reestablishment of the normal anatomy, recognition of a short esophagus, and proper placement of the wrap are essential components of the procedure. Thoracic surgeons with significant laparoscopic and open esophageal surgical experience can perform minimally invasive, complex redo esophageal antireflux procedures safely with good results.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Awais
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Morse
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wilson
authors.forename: William E
authors.initials: WE
authors.lastname: Gooding
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009765:Obesity / Q000601:surgery; D010414:Pennsylvania / Q000453:epidemiology; D011312:Pressure; D011788:Quality of Life; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D055815:Young Adult