Re-operations for failed anti-reflux surgery. Lessons from the Past and Prospects for the Future

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COD: 267-274 Categorie: ,

Marcello Migliore*, Kumarasingham Jeyasingham

Ann. Ital. Chir., 2009; 80: 267-274

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OBJECTIVE: The total number of re-operations for failed antireflux surgery is increasing dramatically worldwide. We
reviewed our experience of re-operations for failed anti-reflux surgery to identify the factors contributing to unsuccessful
re-operation which can be used in the era of laparoscopic surgery.
METHOD: One hundred twentyone patients were re-operated. Only patients whose information responded to 16 variables
were included. Those patients who underwent only 1 re-operation, formed group A, and those who had more than 1
re-operation were included in group B.
RESULTS: Seventy-seven patients entered the study. Fifty-eight patients were included in Group A and 19 in Group B.
Thirty-five patients of Group A were male, whilst 12 of Group B were female. Dysphagia was the leading symptom in
the 1st and subsequent re-operation. After the initial operation, 21 patients developed a symptom different from the main
preoperative one. Nine of these (15%) were in group A, whilst 12 (63%) were in group B (p=0.001). Intra-operative
peri-esophageal fibrosis during the first re-operation was present in 18% of patients of group A, and 47% of group B
(p=0.01). The presence of an anatomical defect was most common in patients of group A (p=0.02). Mean follow-up
was 10.4 years with excellent/good results in 90% of the patients.
CONCLUSION: These findings will help in informing surgeons about the factors influencing the outcome of re-doing operations
for failed anti-reflux surgery. Meticulous diagnosis and operative techniques may permit excellent/good results in
this difficult group of patients.

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