Surgical management after failed antireflux operations

• Published in: World journal of surgery 1992-03, Vol.16 (2), p.359-363
• Main Author: Skinner, David B.
• Format: Article
• Language: English
• Subjects: Alkaline Reflux; Biological and medical sciences; Cette Technique; Esophageal Function; Esophageal Stenosis - classification; Esophageal Stenosis - physiopathology; Esophageal Stenosis - surgery; Esophagitis, Peptic - surgery; Esophagogastric Junction - physiopathology; Esophagogastric Junction - surgery; Esophagus; Gastric Fundus - physiopathology; Gastric Fundus - surgery; Gastroesophageal Reflux - classification; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - surgery; Humans; Medical sciences; Mese; Parmi; Postoperative Complications - classification; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Recurrence; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF02071549

From 1973 to 1989, 117 (28%) patients underwent re‐operation for failed antireflux surgery from a total of 413 esophagogastric operations for gastro‐esophageal reflux disease. Seventy‐eight patients who underwent re‐operation before 1984 were reviewed in detail for classification and long‐term outcome. Forty re‐operations followed a failed Nissen fundoplication, while no other procedure was the most recent prior operation in more than 10 patients. Re‐operation rates were 3% following prior surgery in our clinic for reflux disease other than stricture and 9.6% if the prior operation was done for stricture. There was no difference in re‐operation rates for the Belsey Mark IV or Nissen fundoplication, the 2 most commonly used repairs. In each case, complete pre‐operative evaluations included symptom score, radiography, endoscopy, and esophageal function tests. Based on the results, the 78 patients were classified as pure sphincter mechanism failure to stop reflux (n=14), pure esophageal clearance failure (n=12), combined sphincter mechanism failure and clearance failure (n=29), alkaline reflux (n=9), or no reflux but another condition found (n=14). Patients having symptoms following a prior Nissen fundoplication or Angelchik prosthesis insertion were more likely to have esophageal clearance failure than those having other repairs. The classification proved to be a useful guide to the need for and types of re‐operation chosen. Among the 117 patients undergoing re‐operation, there were 2 (1.7%) deaths within 3 months of surgery and 25 (21%) complications. Long‐term results were directly related to the number of previous operations, with resection and intestinal interposition being the preferred procedure in patients having had 2 or more previous attempts at antireflux surgery. Résumé Entre 1973 et 1985, 117 parmi 413 patients opérés d'un reflux gastro‐oesophagien (28%) ont eu une réintervention pour un échec de la chirurgie anti‐reflux. Soixante dix huit patients, qui ont été opérés avant 1984, ont été évalués en vue d'une classification. Il y a eu 40 réinterventions pour échec de l'opération de Nissen. Cette technique était la seule â être utilisée chez plus de 10 patients. Le taux de réintervention était de 3% dans notre service lorsqu'il n'y avait pas de sténose, et de 9.6% lorsqu'il existait une sténose. Il n'y avait pas de différence entre les taux de réintervention après Nissen ou Belsey Mark IV, les deux procédés utilisés le plus souvent. Dans chaque cas