Laparoscopic Reoperation for Failed Antireflux Procedures

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Abstract
NISSEN fundoplication has long been a popular and successful procedure for the treatment of severe gastroesophageal reflux disease (GERD), with control of symptoms in 85% to 90% or more of patients undergoing fundoplication.1-3 Recently, several prospective studies have demonstrated that the operation can be performed laparoscopically in more than 95% of patients.4-7 These studies have indicated that when the operation is performed by experienced laparoscopic surgeons, excellent symptomatic and physiological results can be achieved with minimal mortality and morbidity rates that are comparable to conventional open antireflux procedures.4-7 In addition, many of the benefits of minimally invasive techniques, such as decreased pain, a shorter hospital stay, and quicker return to regular activity, have been recognized.4-7 An interesting subset of patients has been identified in our practice: patients referred for laparoscopic surgery who have undergone previous antireflux surgery and who then developed recurrent symptoms of GERD or intractable dysphagia. Reoperation for failed antireflux surgery performed prior to the era of minimally invasive surgery has been discussed thoroughly in the literature. Data concerning reoperative laparoscopic antireflux surgery have been sparse. After performing more than 100 primary laparoscopic operations for GERD, we believed that patients undergoing reoperative correction could also benefit from a minimally invasive approach to their disease. The purposes of this study were to evaluate closely 27 patients who developed recurrent symptoms of GERD or intractable dysphagia after primary antireflux surgery to determine which patients were appropriate candidates for a laparoscopic reoperation, to determine if reoperative antireflux surgery was technically feasible, and to evaluate the safety and efficacy of the procedure.