title: Revisional laparoscopic antireflux surgery after unsuccessful endoscopic fundoplication.
abstract: BACKGROUND
  Transoral incisionless fundoplication (TIF), a novel endoscopic procedure for treating gastroesophageal reflux disease (GERD), currently is under evaluation. In case of treatment failure, subsequent revisional laparoscopic antireflux surgery (rLARS) may be required. This study aimed to evaluate the feasibility, safety, and outcomes of revisional antireflux surgery after previous endoscopic fundoplication.
  
  
  METHODS
  Chronic GERD patients who underwent rLARS after a previous TIF procedure were included in the study. Pre- and postoperative assessment included GERD-related quality-of-life scores, proton pump inhibitor (PPI) usage, 24-h pH-metry, upper gastrointestinal endoscopy, and registration of adverse events.
  
  
  RESULTS
  Revisional laparoscopic Nissen fundoplication was feasible for all 15 patients included in the study without conversions to open surgery. Acid exposure of the distal esophagus improved significantly after rLARS, and esophagitis, PPI usage, and hiatal hernia decreased. Quality of life did not improve significantly after rLARS, and 33 % of the patients experienced dysphagia.
  
  
  CONCLUSIONS
  Revisional laparoscopic Nissen fundoplication was feasible and safe after unsuccessful endoscopic fundoplication, resulting in objective reflux control at the cost of a relatively high rate of dysphagia.
authors.affiliation: Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. bplwitteman@gmail.com
authors.forename: Bart P L
authors.initials: BP
authors.lastname: Witteman
authors.forename: Boudewijn F
authors.initials: BF
authors.lastname: Kessing
authors.forename: Gitte
authors.initials: G
authors.lastname: Snijders
authors.forename: Ger H
authors.initials: GH
authors.lastname: Koek
authors.forename: José M
authors.initials: JM
authors.lastname: Conchillo
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Bouvy
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012086:Reoperation
chemical_list: D054328:Proton Pump Inhibitors