Outcomes of redo surgery for failed laparoscopic fundoplication

Abstract

Purpose

The number of operations for laparoscopic antireflux surgery in Japan is much less than that in Western countries. This study's aim was to evaluate outcome measures for redo antireflux surgery (redo-ARS) in Japanese patients.

Methods

Subjects consisted of 11 patients (2.3 %) who required redo-ARS, from an original group of 474 patients who had a primary ARS between December 1994 and January 2015. The mean age of the subjects was 57.7 years, and six of 11 patients were women (55 %). Clinical data were collected in a prospective manner, and were then reviewed retrospectively.

Results

The most common cause of failed primary ARS was dislocation of the wrap (6/11 or 54 %). Of the 11 patients, 10 (91 %) were approached laparoscopically, with one requiring conversion to open surgery. Eight (73 %) underwent redo fundoplication, and the others had hiatal hernia repair alone. Mean operation time and blood loss were 202 min and 56 mL, respectively. A perioperative gastric wall injury occurred in three patients. The postoperative course was uneventful in majority patients. Three (27 %) were required to take proton pump inhibitor (PPI), and two (18 %) had a recurrence of hiatal hernia. A postoperative questionnaire was answered by seven of 11 (63 %), and these all reported a high level of satisfaction with their surgery.

Conclusions

Redo-ARS can be performed safely under laparoscopy. There was no recurrence rate in almost 80 %, and more than 70 % of patients were withdrawn from PPI treatment postoperatively.

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