Abstract
Hypothesis: Laparoscopic techniques can be used to treat patients whose antireflux surgery has failed. Design: Case series. Setting: Two academic medical centers. Patients: Forty-six consecutive patients, of whom 21 were male and 25 were female (mean age, 55.6 years; range, 15-80 years). Previous antireflux procedures were laparoscopic (21 patients), laparotomy (21 patients), thoracotomy (3 patients), and thoracoscopy (1 patient). Main Outcome Measures: The cause of failure, operative and postoperative morbidity, and the level of follow-up satisfaction were determined for all patients. Results: The causes of failure were hiatal herniation (31 patients [67%]), fundoplication breakdown (20 patients [43%]), fundoplication slippage (9 patients [20%]), tight fundoplication (5 patients [11%]), misdiagnosed achalasia (2 patients [4%]), and displaced Angelchik prosthesis (2 patients [4%]). Twenty-two patients (48%) had more than 1 cause. Laparoscopic reoperative procedures were Nissen fundoplication (n = 22), Toupet fundoplication (n = 13), paraesophageal hernia repair (n = 4), Dor procedure (n = 2), Angelchik prosthesis removal (n = 2), Heller myotomy (n = 2), and the takedown of a wrap (n = 1). In addition, 18 patients required crural repair and 13 required paraesophageal hernia repair. The mean ± SEM duration of surgery was 3.5 ± 1.1 hours. Operative complications were fundus tear (n = 8), significant bleeding (n = 4), bougie perforation (n = 1), small bowel enterotomy (n=1), and tension pneumothorax (n = 1). The conversion rate (from laparoscopic to an open procedure) was 20% overall (9 patients) but 0% in the last 10 patients. Mortality was 0%. The mean ± SEM hospital stay was 2.3 ± 0.9 days for operations completed laparoscopically. Follow-up was possible in 35 patients (76%) at 17.2 ± 11.8 months. The well-being score (1 best; 10, worst) was 8.6 ± 2.1 before and 2.9 ± 2.4 after surgery (P
| Original language | English |
|---|---|
| Pages (from-to) | 733-737 |
| Number of pages | 5 |
| Journal | Archives of Surgery |
| Volume | 134 |
| Issue number | 7 |
| DOIs | |
| State | Published - 1999 |
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All Science Journal Classification (ASJC) codes
- Surgery
Cite this
Is laparoscopic reoperation for failed antireflux surgery feasible? / Floch, Neil R.; Hinder, Ronald A.; Klingler, Paul J.; Branton, Susan A.; Seelig, Matthias H.; Bammer, Tanja; Filipi, Charles.
In: Archives of Surgery, Vol. 134, No. 7, 1999, p. 733-737.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Is laparoscopic reoperation for failed antireflux surgery feasible?
AU - Floch, Neil R.
AU - Hinder, Ronald A.
AU - Klingler, Paul J.
AU - Branton, Susan A.
AU - Seelig, Matthias H.
AU - Bammer, Tanja
AU - Filipi, Charles
PY - 1999
Y1 - 1999
N2 - Hypothesis: Laparoscopic techniques can be used to treat patients whose antireflux surgery has failed. Design: Case series. Setting: Two academic medical centers. Patients: Forty-six consecutive patients, of whom 21 were male and 25 were female (mean age, 55.6 years; range, 15-80 years). Previous antireflux procedures were laparoscopic (21 patients), laparotomy (21 patients), thoracotomy (3 patients), and thoracoscopy (1 patient). Main Outcome Measures: The cause of failure, operative and postoperative morbidity, and the level of follow-up satisfaction were determined for all patients. Results: The causes of failure were hiatal herniation (31 patients [67%]), fundoplication breakdown (20 patients [43%]), fundoplication slippage (9 patients [20%]), tight fundoplication (5 patients [11%]), misdiagnosed achalasia (2 patients [4%]), and displaced Angelchik prosthesis (2 patients [4%]). Twenty-two patients (48%) had more than 1 cause. Laparoscopic reoperative procedures were Nissen fundoplication (n = 22), Toupet fundoplication (n = 13), paraesophageal hernia repair (n = 4), Dor procedure (n = 2), Angelchik prosthesis removal (n = 2), Heller myotomy (n = 2), and the takedown of a wrap (n = 1). In addition, 18 patients required crural repair and 13 required paraesophageal hernia repair. The mean ± SEM duration of surgery was 3.5 ± 1.1 hours. Operative complications were fundus tear (n = 8), significant bleeding (n = 4), bougie perforation (n = 1), small bowel enterotomy (n=1), and tension pneumothorax (n = 1). The conversion rate (from laparoscopic to an open procedure) was 20% overall (9 patients) but 0% in the last 10 patients. Mortality was 0%. The mean ± SEM hospital stay was 2.3 ± 0.9 days for operations completed laparoscopically. Follow-up was possible in 35 patients (76%) at 17.2 ± 11.8 months. The well-being score (1 best; 10, worst) was 8.6 ± 2.1 before and 2.9 ± 2.4 after surgery (P
AB - Hypothesis: Laparoscopic techniques can be used to treat patients whose antireflux surgery has failed. Design: Case series. Setting: Two academic medical centers. Patients: Forty-six consecutive patients, of whom 21 were male and 25 were female (mean age, 55.6 years; range, 15-80 years). Previous antireflux procedures were laparoscopic (21 patients), laparotomy (21 patients), thoracotomy (3 patients), and thoracoscopy (1 patient). Main Outcome Measures: The cause of failure, operative and postoperative morbidity, and the level of follow-up satisfaction were determined for all patients. Results: The causes of failure were hiatal herniation (31 patients [67%]), fundoplication breakdown (20 patients [43%]), fundoplication slippage (9 patients [20%]), tight fundoplication (5 patients [11%]), misdiagnosed achalasia (2 patients [4%]), and displaced Angelchik prosthesis (2 patients [4%]). Twenty-two patients (48%) had more than 1 cause. Laparoscopic reoperative procedures were Nissen fundoplication (n = 22), Toupet fundoplication (n = 13), paraesophageal hernia repair (n = 4), Dor procedure (n = 2), Angelchik prosthesis removal (n = 2), Heller myotomy (n = 2), and the takedown of a wrap (n = 1). In addition, 18 patients required crural repair and 13 required paraesophageal hernia repair. The mean ± SEM duration of surgery was 3.5 ± 1.1 hours. Operative complications were fundus tear (n = 8), significant bleeding (n = 4), bougie perforation (n = 1), small bowel enterotomy (n=1), and tension pneumothorax (n = 1). The conversion rate (from laparoscopic to an open procedure) was 20% overall (9 patients) but 0% in the last 10 patients. Mortality was 0%. The mean ± SEM hospital stay was 2.3 ± 0.9 days for operations completed laparoscopically. Follow-up was possible in 35 patients (76%) at 17.2 ± 11.8 months. The well-being score (1 best; 10, worst) was 8.6 ± 2.1 before and 2.9 ± 2.4 after surgery (P
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UR - http://www.scopus.com/inward/citedby.url?scp=0033017583&partnerID=8YFLogxK
U2 - 10.1001/archsurg.134.7.733
DO - 10.1001/archsurg.134.7.733
M3 - Article
VL - 134
SP - 733
EP - 737
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 7
ER -