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 24 November 2017

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News

Repeat surgery for failed antireflux surgery

Laparoscopic repeat surgery for recurrent or persistent symptoms of gastroesophageal reflux disease is effective and safe, finds a research team in the latest issue of the International Journal of Colorectal Disease.

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Laparoscopic antireflux surgery has recently become the standard procedure for treating severe gastroesophageal reflux disease.

Mean Gastrointestinal Quality of Life Index was equal to that of a healthy population after 1 year.
International Journal of Colorectal Disease

However, both laparoscopic antireflux surgery and open surgery can cause failures, which leads to repeat surgery in 3 to 6% of cases.

In this study, researchers from Austria evaluated both quality of life and surgical outcome following laparoscopic refundoplication for failed initial antireflux surgery.

The team prospectively studied 51 patients undergoing laparoscopic refundoplication for primary failed antireflux surgery. Patients were followed up for 1 year after surgery.

The researchers found that in 20 cases the initial surgery used the open technique, and 4 patients had had surgery twice previously.

In 31 cases the primary procedure was performed laparoscopically.

The team found that indications for repeat surgery were recurrent reflux in 29 patients, dysphagia in 12, and a combination of both in 10 patients.

They used preoperative and postoperative data including 24-h pH monitoring, esophageal manometry, and quality of life (Gastrointestinal Quality of Life Index) to assess outcome.

Overall, 49 repeat procedures were completed by the laparoscopic technique. However, conversion was necessary in 2 cases with primary open procedure, in 1 patient because of injury to the gastric wall, and in 1 severe bleeding of the spleen.

The team found that postoperatively 2 patients suffered from dysphagia. They required pneumatic dilatation within the first postoperative year.

Average operating time was 245 min after an initial open procedure and 80 min after an initial laparoscopic procedure.

The researchers determined that lower esophageal sphincter pressure had increased significantly at 3 months and 1 year after repeat surgery. In these cases the DeMeester score decreased significantly from preoperative, at 3 months and at 1 year after surgery.

The team also found that the mean Gastrointestinal Quality of Life Index increased from 86.7 points preoperatively to 121.6 points at 3 months and 123.8 points at 1 year. This was comparative to that of a healthy population.

Dr Frank Alexander Granderath's team concluded, "Laparoscopic repeat surgery for recurrent or persistent symptoms of gastroesophageal reflux disease is effective".

And, "Can be performed safely with excellent postoperative results and a significant improvement in patient's quality of life for a follow-up period of 1 year".

Int J Colorectal Dis (2003) 18: 248-53
16 April 2003

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