title: Laparoscopic repair for failed antireflux procedures.
abstract: BACKGROUND
  Minimally invasive procedures have become common, and more reoperations for failed antireflux procedures are performed laparoscopically. We wanted to study the outcomes of laparoscopic reoperations for reflux.
  
  
  METHODS
  Medical records of all patients who underwent reoperation without esophageal resection after previous antireflux procedures between January 2000 and October 2012 were reviewed.
  
  
  RESULTS
  Seventy-five patients were included in this report: 56 (77%) women and 19 (23%) men. Median age was 58 years. The previous operation was laparoscopic antireflux procedures in 65 (87%) patients. The median interval between the last antireflux procedure and laparoscopic reoperation was 42 months. The median body mass index (BMI) was 28.7. All patients were symptomatic. Intraoperative findings included recurrent hiatal hernia in 47 (63%) patients, incompetent fundoplication in 14 (19%) patients, tight fundoplication in 8 (11%) patients, and tight crura in 2 (3%) patients. Laparoscopic Nissen fundoplication was performed in 57 (76%) patients, partial posterior fundoplication was performed in 12 (16%) patients, partial anterior fundoplication was performed in 3 (4%) patients, removal of crural stitches was performed in 2 patients, and a combination of partial posterior fundoplication and removal of crural stiches was performed in 1 patient. Complications occurred in 13 (15%) patients. Improvement in symptoms was observed in 70 (93%) patients in early postoperative follow-up and in 59 (78%) patients in long-term follow-up. Functional results were classified as excellent in 59 (78%) patients, good in 6 (7%) patients, fair in 7 (8%) patients, and poor in 3 (4%) patients.
  
  
  CONCLUSIONS
  Laparoscopic reoperation for failed antireflux operations is a complex procedure, but it is safe and effective in selected patients. Reoperation after a failed antireflux repair results in excellent or good functional status in a majority of patients, but these results may deteriorate over time.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: George
authors.initials: G
authors.lastname: Makdisi
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: deschamps.claude@mayo.edu.
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D017211:Treatment Failure