title: Clinical Outcomes of Reoperation for Failed Antireflux Operations.
abstract: BACKGROUND
  Up to 18% of patients undergoing antireflux operations will require reoperation. Authors caution that with each additional reoperation, fewer patients achieve satisfaction. The quality of life in patients who underwent revision operations was compared with patients who underwent primary antireflux operations to determine the effectiveness of revision operations.
  
  
  METHODS
  We retrospectively reviewed patients who underwent revision after failed antireflux operations from 2004 to 2014. Patients were divided into two groups: first reoperation (Reop[1]) and more than one reoperation (Reop[>1]). For comparison, a control group of patients who underwent primary antireflux operations was included. Patients underwent quality of life assessment preoperatively and postoperatively.
  
  
  RESULTS
  We identified 105 reoperative patients: 94 Reop(1), 11 Reop(>1), and 112 controls. The primary reason for failure was combined fundoplication herniation and slippage. Morbidity, mortality, and readmission rates were similar in all groups. Postoperative outcomes were improved in all groups but to a lesser degree in subsequent reoperations. Gastroesophageal Reflux Disease Health-Related Quality of Life: controls, 20.0 to 2.0; Reop(1), 26.5 to 4.0; and Reop(>1), 13.0 to 2.0. Quality of Life in Reflux and Dyspepsia: controls, 4.5 to 7.0; Reop(1), 3.7 to 6.7; and Reop(>1), 3.5 to 5.8. Dysphagia Severity Score: controls, 44.0 to 45.0; Reop(1), 36.0 to 45.0; and Reop(>1), 30.8 to 45.0.
  
  
  CONCLUSIONS
  Patients undergoing revision antireflux operations have improved quality of life, relatively normal swallowing, and primary symptom resolution at a median of 20 months postoperatively. However, patients who undergo more than one reoperation have lower quality of life scores and less improvement in dysphagia, suggesting that other procedures such as Roux-en-Y or short colon interposition, should be considered after a failed initial reoperation.
authors.affiliation: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
authors.forename: Candice L
authors.initials: CL
authors.lastname: Wilshire
authors.affiliation: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington. Electronic address: brian.louie@swedish.org.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.affiliation: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
authors.forename: Dale
authors.initials: D
authors.lastname: Shultz
authors.affiliation: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Jutric
authors.affiliation: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farivar
authors.affiliation: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D015390:Gastric Bypass / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome