Is laparoscopic reoperation for failed antireflux surgery feasible?

Neil R. Floch, Ronald A. Hinder, Paul J. Klingler, Susan A. Branton, Matthias H. Seelig, Tanja Bammer, Charles Filipi

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)733-737
Number of pages5
JournalArchives of Surgery
Volume134
Issue number7
DOIs
StatePublished - 1999

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Reoperation
Fundoplication
Hiatal Hernia
Herniorrhaphy
Prostheses and Implants
Thoracoscopy
Esophageal Achalasia
Pneumothorax
Thoracotomy
Diagnostic Errors
Tears

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Floch, N. R., Hinder, R. A., Klingler, P. J., Branton, S. A., Seelig, M. H., Bammer, T., & Filipi, C. (1999). Is laparoscopic reoperation for failed antireflux surgery feasible? Archives of Surgery, 134(7), 733-737. https://doi.org/10.1001/archsurg.134.7.733

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 journalArticle

Floch, NR, Hinder, RA, Klingler, PJ, Branton, SA, Seelig, MH, Bammer, T & Filipi, C 1999, 'Is laparoscopic reoperation for failed antireflux surgery feasible?', Archives of Surgery, vol. 134, no. 7, pp. 733-737. https://doi.org/10.1001/archsurg.134.7.733
Floch NR, Hinder RA, Klingler PJ, Branton SA, Seelig MH, Bammer T et al. Is laparoscopic reoperation for failed antireflux surgery feasible? Archives of Surgery. 1999;134(7):733-737. https://doi.org/10.1001/archsurg.134.7.733
Floch, Neil R. ; Hinder, Ronald A. ; Klingler, Paul J. ; Branton, Susan A. ; Seelig, Matthias H. ; Bammer, Tanja ; Filipi, Charles. / Is laparoscopic reoperation for failed antireflux surgery feasible?. In: Archives of Surgery. 1999 ; Vol. 134, No. 7. pp. 733-737.
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